Evaluation on safety and effectiveness of ultrasonographic scoring system in different treatment methods for cesarean scar pregnancy

Qiang HUANG; Jinhong XIANG; Li LUO; Zhengqiong CHEN; Qiulei SUN

doi:10.16016/j.1000-5404.202005293

您当前的位置：

首页 >

文章列表页 >

Evaluation on safety and effectiveness of ultrasonographic scoring system in different treatment methods for cesarean scar pregnancy

Clinical Medicine | 更新时间：2026-01-09

- Evaluation on safety and effectiveness of ultrasonographic scoring system in different treatment methods for cesarean scar pregnancy
- Journal of Third Military Medical University Vol. 42, Issue 21, Pages: 2128-2133(2020)
- 作者机构：
  
  400037 重庆，陆军军医大学(第三军医大学)第二附属医院妇产科
- 作者简介：
- 基金信息：
  
  the General Program of Technology Innovation, Application and Development of Chongqing Science and Technology Bureau(CSTC2019jscx-msxmX0269)
- DOI：10.16016/j.1000-5404.202005293
  CLC： R445.1;R619.6;R714.2
- Received：31 May 2020，
  
  Revised：2020-08-25，
  
  Published：15 November 2020
- 稿件说明：
移动端阅览
Qiang HUANG, Jinhong XIANG, Li LUO, et al. Evaluation on safety and effectiveness of ultrasonographic scoring system in different treatment methods for cesarean scar pregnancy[J]. Journal of Third Military Medical University, 2020, 42(21): 2128-2133.
DOI：

Qiang HUANG, Jinhong XIANG, Li LUO, et al. Evaluation on safety and effectiveness of ultrasonographic scoring system in different treatment methods for cesarean scar pregnancy[J]. Journal of Third Military Medical University, 2020, 42(21): 2128-2133. DOI： 10.16016/j.1000-5404.202005293.

摘要

目的

对超声评分系统下不同风险组剖宫产瘢痕妊娠不同处理方式的安全性及有效性进行比较和评价。

方法

回顾性分析2018年11月至2019年12月于陆军军医大学第二附属医院妇产科住院手术治疗的299例剖宫产瘢痕部位妊娠的病例资料。根据术前超声评分系统将患者分为高风险组(评分>4分)和低风险组(评分≤4分)，低风险组行B超引导下清宫术，高风险组行子宫动脉栓塞术+B超引导下清宫术。收集患者基本信息、围术期资料及术后随访资料并进行统计学分析。

结果

两组患者术中出血量差异无统计学意义。两组治疗后需再次行子宫动脉栓塞术的发生率差异无统计学意义

而需要再次腹腔镜下瘢痕妊娠病灶去除术的发生率差异有统计学意义(

0.05)。两组患者住院时间和花费差异有统计学意义(

0.05)。两组患者术后血清β-HCG水平恢复至正常的时间、B超子宫下段异常回声消失的时间、月经恢复正常的时间差异均有统计学意义(

0.05)。而治疗后两组患者再次妊娠的结局差异无统计学意义。

结论

根据术前超声评分系统，对不同风险组的剖宫产瘢痕妊娠选择相应的处理方式均安全有效。

Abstract

Objective

To evaluate and compare the efficacy and safety of different managements for women with cesarean scar pregnancy based on a ultrasonographic scoring system.

Methods

A total of 299 pregnant women with cesarean scar undergoing delivery surgeries in our department from November 2018 to December 2019 were recruited retrospectively. According to the preoperative results of the ultrasonographic scoring system

they were divided into low-risk group (score ≤4) and high-risk group (score > 4). The patients in the low-risk group were treated with ultrasound-guided curettage. And those of the other group were treated with uterine artery embolization and ultrasound-guided curettage. The basic information

perioperative data and postoperative follow-up data of the patients were collected and analyzed.

Results

There was no statistical difference in the amount of intraoperative blood loss between the 2 groups (

0.05)

neither the incidence of secondary uterine artery embolization between them (

0.05). But significant difference was found in the incidence of secondary laparoscopic procedure for removing scar tissues between the 2 groups (

0.05). What's more

there were obvious differences in the length of hospital stay and total cost

the time of postoperative serum β-HCG level dropping to normal

the time of disappearance of the abnormal echoes in the lower segment of the uterus

and the restoration of normal menstruation between the 2 groups (

0.05). However

there was no statistical significance of the outcome of the second pregnancy between them after treatment.

Conclusion

According to the preoperative ultrasonographic scoring system for cesarean scar pregnancy

patients in different treatment methods.

关键词

Keywords

references

KIM S Y, YOON S R, KIM M J, et al . Cesarean scar pre-gnancy; Diagnosis and management between 2003 and 2015 in a single center[J ] . Taiwan J Obstet Gynecol, 2018, 57(5): 688-691. DOI:10.1016/j.tjog.2018.08.013.

SUN Q L, LUO L, GAO C Y, et al . Scoring system for the prediction of the successful treatment modality in women with cesarean scar pregnancy[J ] . Int J Gynecol Obstet, 2019, 146(3): 289-295. DOI:10.1002/ijgo.12881.

ASH A, SMITH A, MAXWELL D. Caesarean scar pregnancy[J]. Int J Obstet Gynaecol, 2007, 114(3): 253-263. DOI:10.1111/j.1471-0528.2006.01237.x.

TANAKA K, COGHILL E, BALLARD E, et al . Management of Caesarean scar pregnancy with high dose intravenous metho-trexate infusion therapy: 10-year experience at a single tertiary centre[J ] . Eur J Obstet Gynecol Reproductive Biol, 2019, 237: 28-32. DOI:10.1016/j.ejogrb.2019.04.008.

MAHEUX-LACROIX S, LI F, BUJOLD E, et al . Cesarean scar pregnancies: a systematic review of treatment options[J ] . J Minim Invasive Gynecol, 2017, 24(6): 915-925. DOI:10.1016/j.jmig.2017.05.019.

BIRCH PETERSEN K, HOFFMANN E, RIFBJERG LARSEN C, et al . Cesarean scar pregnancy: a systematic review of treatment studies[J ] . Fertil Steril, 2016, 105(4): 958-967. DOI:10.1016/j.fertnstert.2015.12.130.

HARB H M, KNIGHT M, BOTTOMLEY C, et al . Caesarean scar pregnancy in the UK: a national cohort study[J ] . Int J Obstet Gy, 2018, 125(13): 1663-1670. DOI:10.1111/1471-0528.15255.

张智勤, 黄秀敏, 周小峰.剖宫产瘢痕妊娠终止妊娠手术中出血量的相关因素研究[J].中国实用妇科与产科杂志, 2018, 34(10): 1130-1133. DOI:10.19538/j.fk2018100115.

ZHANG Z Q, HUANG X M, ZHOU X F. Factors related to the amount of intraoperative blood loss in CSP termination surgery[J]. Chin J Pract Gynecol Obstet, 2018, 34(10): 1130-1133. DOI:10.19538/j.fk2018100115.

TIMOR-TRITSCH I E, MONTEAGUDO A. Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy. A review[J]. Am J Obstet Gynecol, 2012, 207(1): 14-29. DOI:10.1016/j.ajog.2012.03.007.

MORRIS C S. Update on uterine artery embolization for symptomatic fibroid disease (uterine artery embolization)[J]. Abdom Imaging, 2008, 33(1): 104-111. DOI:10.1007/s00261-007-9187-3.

CHEN H H, ZHOU J R, WANG H S, et al . The treatment of cesarean scar pregnancy with uterine artery embolization and curettage as compared to transvaginal hysterotomy[J ] . Eur J Obstet Gynecol Reprod Biol, 2017, 214: 44-49. DOI:10.1016/j.ejogrb.2017.04.032.

MOHAN P P, HAMBLIN M H, VOGELZANG R L. Uterine artery embolization and itseffect on fertility[J]. J Vasc Interv Radiol, 2013, 24(7): 925-930. DOI:10.1016/j.jvir.2013.03.014.

XIAO Z N, CHENG D, CHEN J, et al .The effects of metho-trexate and uterine arterial embolization in patients with cesarean scar pregnancy: a retrospective case-control study[J ] . Medicine (Baltimore), 2019, 98(11):e14913. DOI: 10.1097/MD.0000000000014913.

陈春林, 刘萍.血管性介入治疗在妇产科领域中的应用[J].中华妇产科杂志, 2004, 39(2): 138-141. DOI:10.3760/j.issn:0529-567X.2004.02.023.

CHEN C L, LIU P. Application of vascular interventional therapy in gynecology and obstetrics [J]. Chin J Obstet Gynecol, 2004, 39(2): 138-141. DOI:10.3760/j.issn:0529-567X.2004.02.023.

KRISSI H, HIERSCH L, STOLOVITCH N, et al . Outcome, complications and future fertility in women treated with uterine artery embolization and methotrexate for non-tubal ectopic pregnancy[J ] . Eur J Obstet Gynecol Reproductive Biol, 2014, 182: 172-176. DOI:10.1016/j.ejogrb.2014.09.026.

STEPNIAK A, PASZKOWSKI T, JARGIEŁŁO T, et al . Effectiveness, complications and reproductive outcome of selective chemoembolization with methotrexate followed by suction curettage for Caesarean scar pregnancy—a prospective observational study[J ] . Eur J Obstet Gynecol Reprod Biol, 2019, 241: 56-59. DOI:10.1016/j.ejogrb.2019.08.004.

LEVIN G, ZIGRON R, DIOR U P, et al . Conservative management of Caesarean scar pregnancies with systemic multidose methotrexate: predictors of treatment failure and reproductive outcomes[J ] . Reprod Biomed Online, 2019, 39(5): 827-834. DOI:10.1016/j.rbmo.2019.05.015.

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Clinical efficacy of curettage in treating cesarean scar pregnancy: a randomized controlled trial

Reproductive outcomes of women with cesarean scar pregnancy after uterine artery chemoembolization combined with evacuation

Clinical analysis of bilateral uterine artery embolization for placenta accreta

Related Author

YANG Ying

ZHOU Lu

LUO Li

XIONG Xi

CHEN Zhengqiong

Tingting TAN

Qiulei SUN

Li LUO

Related Institution

Department of Obstetrics and Gynecology， Second Affiliated Hospital， Army Medical University （Third Military Medical University）

⁰