剖宫产术后子宫疤痕处妊娠51例临床分析

目的:分析51例确诊为剖宫产术后疤痕妊娠病例的临床表现、诊断、处理、治疗经过及预后。方法:诊断主要依据B超检查、全子宫切除标本及病理;治疗用MTX肌注20例,静滴MTX加孕囊穿刺术7例,天花粉肌注9例,忽略疤痕妊娠人工流产术时大出血,术后使用MTX加米非司酮或单用米非司酮治疗8例,因大出血行全子宫切除术8例(其中1例药物治疗失败)。结果:药物治疗36例,失败1例(行全子宫切除术),余35例治疗后正常转经,4例一年后再次妊娠,无明显副作用及并发症。忽略疤痕妊娠人工流产术中均有大出血史,平均出血量658±244ml,因大出血行全子宫切除术者,平均出血量2800±1450ml。结论:疤痕子宫妊娠应及早做B超检查,一旦发现疤痕部位妊娠,采用药物治疗是一种安全有效的方法。

Pregnancy at Uterine Scar Caused by Previous Cesarean Section

Objective: To explore the clinical presentation, diagnosis, treatment and prognosis of 51 cases of cesarean scar pregnancy. Methods: Diagnosis mainly depended on B mode of ultrasonic scan, pathology of the specimen of hysterectomy. Treatment included intramuscular MTX in 20 cases, intravenous MTX plus aspiration of gestational sac in 7 cases, and intramuscular Trichosanthin in 9 cases. For misdiagnosed cesarean scar pregnancies, profuse bleeding occurred during dilation and curettage ( D & C), 8 of them were then treated with MTX and mifepristone or mifepristone alone after operation, the rest 8 cases underwent hysterectomy because of life - threatening bleeding ( one of them was from the medical group). Results: Medical therapy was performed in 36 cases, failed in one who had hysterectomy later. 35 success cases returned to normal menstrual cycles, with no obvious side effects or complication developed, and 4 of them were pregnant after one year. While profuse bleeding was encountered in all misdiagnosed cases who underwent D & C firstly, and the average amount of bleeding was 658±244ml. For those undergoing hysterectomy, the average amount of bleeding was 2800±1450ml. Conclusion: Cesarean scar pregnancy should be diagnosed by ultrasound in the early stage. Once such pregnancy is diagnosed, medication should be applied as the first approach, which is safe and effective.