关键词: 瘢痕妊娠, 经阴道彩色多普勒超声, 超声分型, 个体化治疗方案

Abstract: Objective To compare the data of cesarean scar pregnancy (CSP) after cesarean section with that of the control group, so as to provide help for the early diagnosis of CSP. To compare the ultrasonic characteristics and treatment methods of different ultrasonic types of CSP, so as to provide an objective basis for early diagnosis and individualized treatment. Methods The ultrasonographic features and related clinical indexes of 41 CSP patients and 41 control patients were analyzed retrospectively, the treatment methods adopted by patients with different types of CSP were summarized and analyzed. Results The probability of vaginal bleeding in 41 patients with CSP was higher than that in 41 control patients, the difference was statistically significant (P<0.05). According to ultrasonic classification, CSP is divided into four types: Ⅰ, Ⅱ, ⅢA and ⅢB. Compared with other 3 types CSPs, patients with type Ⅰ CSP had higher probability of vaginal bleeding, which difference was statistically significant (P<0.05). The main treatment of type Ⅰ CSP was ultrasound-guided uterine curettage, each method could be selected according to the actual clinical situation for type Ⅱ CSP, type Ⅲ CSP mainly adopted ultrasound-guided uterine curettage after uterine artery embolization. All patients had little intraoperative bleeding, good prognosis and been discharged successfully. Conclusions There were some differences in clinical indexes between CSP patients and control patients, but they were not specific enough. Therefore, in order to diagnose CSP as soon as possible, for the early pregnancy examination of second pregnancy in patients with cesarean section, we must clarify the relationship between gestational sac and scar of the lower part of the anterior wall of uterus and bladder. Ultrasound typing is helpful to formulate an individualized treatment plan for CSP patients to improve the prognosis. Therefore, accurate ultrasonic typing is also needed when diagnosing CSP.

Key words: CSP, transvaginal color Doppler ultrasound, ultrasonic typing, individualized treatment