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The Clinical Research of Forty-four Cases of Cesarean Scar Pregnancy

Author: ShaoXiuFang
Tutor: YangYin
School: Fujian Medical
Course: Obstetrics and Gynaecology
Keywords: Cesarean scar pregnancy Clinical research TianHuaFen Intervention
CLC: R714.2
Type: Master's thesis
Year: 2011
Downloads: 99
Quote: 0
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Abstract


Objective:Explore the clinical manifestations, diagnosis, treatment and therapeutic effect of patients with cesarean scar pregnancy.Methods:From 2002 to 2010, we accepted a total of 44 cases of patients with cesarean scar pregnancy to hospitalize. They respectively accepted conservative treatment and surgery treatment. Conservative groups:15 cases in group A:TianHuaFen cervical injection; 14 cases in group B: MTX muscle injection and mifepristone influences oral; 8 cases in group C: uterine artery embolization and artery perfusion MTX. Group D of 7 cases with surgery. To retrospectively analyze the clinical date of each of the above groups, such as the clinical manifestation, ultrasonic auditory image,β-HCG levels, treatment effectiveness and length of stay.Results:1. There were 32 cases in the 44 patients emerging vaginal irregular bleeding symptom, 7 cases having no clinical symptoms, 3 cases misdiagnosing abortion to adopt dilation and curettage of uterus rusulting in vagina hemorrhea, and 1 case after childbirth occurring vagina hemorrhea because of placenta imbeding muscular layer.2. 41 cases were diagnosed through the ultrasound. The diagnose accordance rate(100%)of transvaginal ultrasound comparing with the diagnose accordance rate(80%) of abdominal ultrasound had statistically significant (P<0.05).3. Comparing conservative groups anterior-posterior treatment’ clinical index: bloodβ-HCG level of group C was higher than group A and group B and the difference had statistical significance (P<0.05); The rate of the number of lesions with blood rich in group C was higher than group A and group B and the difference had statistical significance(P<0.05); Intraoperative blood volume of group C was less than group A and group B and the difference had statistical significance(P<0.05); Length of stay of group C was shorter than group A and group B and the difference had statistical significance(P<0.05). Surgery group: intraoperative blood volume of surgery after intervention was less than that of direct surgery.4. Therapeutic effect: group A was cured 14 cases, and 1 case was changed to surgery after intervention; Group B was cured 13 cases, and 1 case was changed to surgery; Group C was cured 7 cases, and 1 case was changed to surgery; Group D was all cured. All the patients were cured to discharge from and no one readmitded after post-discharge.Conclusion:1. Most patients of cesarean scar pregnancy appear irregular vaginal bleeding in early gestation, just a few without any clinical symptom. Because of nonspecific clinical characteristics, we easily misdiagnose abortion to adopt dilation and curettage of uterus rusulting in vagina hemorrhea, and then threaten patients lives.2. Color doppler ultrasonography is principal diagnosis, especially transvaginal ultrasound accuracy is higher.3. TianHuaFen cervical injection, MTX muscle injection and mifepristone influences oral therapy, Uterine artery embolization and artery perfusion MTX treatment and operation all can acquire a good therapeutic effect, if we make appropriate use of them. To the patients with high ?-HCG value and lesions with blood rich, choosing uterine artery embolization and artery perfusion MTX treatment has high safety. Surgery is not considered as a routine treatment.

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CLC: > Medicine, health > Obstetrics and Gynaecology > Obstetrics > Pathological pregnancy ( abnormal pregnancy )
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