Therapeutic Strategies And Risk Factors Of Caesarean Scar Pregnancy

Objective: To explore the treatment strategies and risk factors of Caesarean Scar Pregnancy.Methods: This study was to retrospectively analyze 23 cases of scar pregnancy diagnosed in our hospital from January 2015 to December 2018,and to include 21 cases of normal pregnancy of scar uterus in the same period as control.After fully communicating with patients and their families,we consulted about the risks of hysterectomy.The treatment strategies included methotrexate(MTX)chemotherapy,uterine artery embolization,hysterectomy,hysteroscopy and laparoscopic local excision of scar pregnancy focus combined with chemotherapy,as well as comprehensive treatment due to the specific conditions of the treatment process,and collected follow-up beta-HCG detection,and so on.Transvaginal ultrasound and other clinical data.Results: There were significant differences between 23 cases of scar pregnancy and21 cases of normal pregnancy(P < 0.05).Further logistic regression analysis showed that the number of abortions,the thickness of muscular layer,the interval between two pregnancies less than 3 years,and the thickness of scar had statistical significance in logistic regression analysis(p < 0.05),while the scar constitution had no statistical significance.Four of the six patients were cured after chemotherapy.Among 6 patients treated with MTX alone,4 were cured;1 patient was converted to uterine artery embolization after two failures of chemotherapy;1 patient had poor efficacy of chemotherapy,hemorrhagic shock occurred during the course of treatment,and was switched to total hysterectomy.The cure rate was 66.7%(4/6).One case had gastrointestinal reactions such as nausea and gastric anorexia,and one case had hair loss.The incidence of side effects was 33.3%(2/6).All the 7 patients were successfully operated on.One patient developed fever after operation.After anti-inflammatory treatment,the incidence of complications was 14.3%(1/7).Three patients who underwent total abdominal hysterectomy were all fertile and had no fertility requirement.Two cases underwent laparoscopic local excision of scar pregnancy,and five cases underwent hysteroscopic resection of residual tissue of cesarean section incision.No operative complications occurred and all the cases recovered well.There was no significant difference in the recovery time of HCG between simple chemotherapy group and uterine artery embolization combined chemotherapy group(P=0.503).There was significant difference between laparoscopic local lesion resection combined chemotherapy group and simple chemotherapy group(P=0.033),uterine artery embolization combined chemotherapy group(P=0.019).The recovery time of HCG between simple chemotherapy group and local uterine lesion resection combined with chemotherapy group was also significantly different.The other two groups were short.There was significant difference in the recovery time of normal menstruation(F=2.305,P=0.023).The incidence of complications in the chemotherapy group was higher than that in the other groups,while the pregnancy rate in the combined chemotherapy group was higher than that in the other groups.Conclusion: 1)Abortion times(> 3 times),muscle thickness(< 0.3 cm),interval between two pregnancies(< 3 years)and scar thickness(> 0.3 cm)are the important high risk factors for scar pregnancy in cesarean section.2)The treatment strategy of hysteroscopic resection of residual tissue of cesarean section incision has the advantages of less bleeding,shorter recovery time and definite curative effect.