The Clinical Analysis Of 53 Cases With Cesarean Scar Pregnancy

OBJECTIVE:To retrospectively analyze 53 cases with CSP,hospitalized from January 2013 to August 2017,to summarize the high risk factors of CSP and the influences on outcome after different therapy,in order to find the individualized treatment for the patient.MATERIALS AND METHODS:53 cases with CSP hospitalized from January 2013 to August 2017 in our hospital were selected as an experimental group,90 cases of term delivered after a prior cesarean section as the control group.Some factors were analyzed,including the age of patients,the number of induced abortion,the interval after the prior cesarean delivery and the indications of previous cesarean section(premature rupture of membranes,placental abruption,breech position).The relation-ship between this factors and the incidences of CSP were studied as well.The experimental group included three types and the differences of these three types were observed.The experimental group was further subdivided into three groups according to different treatment methods,which were compared by statistical method.SPSS 22.0 software was used to statistical analysis,using chi-square test,P=0.05 acted as level of significance.RESULTS:1.The morbidity of cesarean scar pregnancy was increasing along with the time was more than the one of CSP ? and especially for the last two years.Among the three types of CSP,the incidence of CSP ? was gradually declining.2.The minimum age of the CSP group was 20-year-old,the maximum age was 42-year-old,the average age was 33-year-old.Compared with the control group,there is no statistical significance(P=0.369).3.When the number pregnancy,artificial abortion and ces-arean section were compared with the control group,the differences were statistically significant(P=0.006,0.018,0.000 respectively).4.There was no statistic difference concerning the interval from the previous cesarean section between CSP group and control group(P=0.893).5.As to the indications of the prior cesarean section,if the prior CS was a breech presentation,the incidence of CSP were significant higher than those in control group(P=0.021).If the indications of prior CS were the premature rupture of membranes and placental abruption cesarean section,there were no statistic difference about the incidence of CSP compared with control group(P=0.708,0.890 respectively).6.Three types of CSP patients had a statistically significant difference in age.The age of patients in CSP ? was smaller than that of the other two types(P=0.012).7.When compared the time interval after the previous cesarean section,and the ?-HCG level before treatment,there were no statistic difference between these three types(P=0.683,0.472 respectively).8.The patients with type CSP ? and CSP ? were mostly treated with method A,namely drug pretreatment(MTX or mifepristone)followed by curettage under hysteroscopy/ultra-sound.The CSP ? patients were mainly given method B(cesarean scar excision and uterine repair via abdominal or laparoscopic or vaginal).9.The patients treated with method C(pretreated with uterine artery embolization before curettage under ultra-sound)had longer time of amenorrhea than method A and method B.10.The expenses of hospitalization among three treatments showed that the cost of patients treated with method B was higher than that of method C and method A(P=0.000).11.Comparison of bleeding during operation among three treatments.The difference was statistically significant(P=0.000).Patients treated with method B had more bleeding than those treated with method C and method A.12.There was no statistical difference about hospitalization time among three treatments(P=0.211).CONCLUSION:The morbidity of cesarean scar pregnancy was increasing along with the time especially for the last two years.The risk factors of CSP include the number of pregnant equal or greater than the number of abortion equal or greater than the number of cesarean section.The time interval from the previous cesarean section has no correlation with the occurrence of CSP.The age of CSP ? patients is smaller than that of CSP ? patients and CSP ? patients.The patients pretreated with uterine artery embolization before curettage under ultrasound had longer time of amenorrhea.The CSP typing has important clinical significant for individual treatment options.Cesarean scar excision and uterine repair has more hospitalization expenses and bleeding during operation.