BACKGROUND Cesarean scar pregnancy(CSP)is rare but may result in uterine rupture during pregnancy or massive hemorrhage during abortion procedures.Awareness of this condition is increasing,and most patients with CSP a...BACKGROUND Cesarean scar pregnancy(CSP)is rare but may result in uterine rupture during pregnancy or massive hemorrhage during abortion procedures.Awareness of this condition is increasing,and most patients with CSP are now diagnosed early and can be managed safely.However,some atypical patients are misdiagnosed,and their surgical risks are underestimated,increasing the risk of fatal hemorrhage.CASE SUMMARY A 27-year-old Asian woman visited our institution because of abnormal pregnancy,and she was diagnosed with a hydatidiform mole through transvaginal ultrasound(TVS).Under hysteroscopy,a large amount of placental tissue was found in the scar of the lower uterine segment,and a sudden massive hemorrhage occurred during the removal process.The bilateral internal iliac arteries were temporarily blocked under laparoscopy,and scar resection and repair were rapidly performed.She was discharged in good condition 5 d after the operation.CONCLUSION Although TVS is widely used in the diagnosis of CSP,delays in the diagnosis of atypical CSP remain.Surgical treatment following internal iliac artery temporary occlusion may be an appropriate management method for unanticipated massive hemorrhage during CSP surgery.展开更多
Objective:This paper aims to summarize the operative nursing coordination essentials of type III cesareans car pregnancy removal.Methods:Six patients were recruited for this study,and the patient’s condition was full...Objective:This paper aims to summarize the operative nursing coordination essentials of type III cesareans car pregnancy removal.Methods:Six patients were recruited for this study,and the patient’s condition was fully evaluated before the operation.In addition,the personnel,environment,and materials were well prepared before the operation,and the preparation of special intraoperative instruments and equipment was perfected.Results:The operation is successfully performed in all six patients.Each surgery lasted 70 to 120 minutes with an average duration of 90 minutes.Postoperative blood loss was about 100-500 ml.Postoperative recovery was good without complications in all the patients.Conclusion:In summary,laparoscopic removal of gestational tissue from type III cesareans car pregnancy in conjunction with hysteroscopy ensures compete removal of gestational tissue,while avoiding damaging the surrounding organs and tissues,thus greatly avoiding common complications which usually occur during the surgery.Effective surgical coordination is helpful to further improve the success rate of the operation.展开更多
Background: There is no consensus regarding the optimal treatment for cesarean scar pregnancy (CSP) because treatment efficacy, safety, and the influence on subsequent pregnancy must be taken into consideration. Here ...Background: There is no consensus regarding the optimal treatment for cesarean scar pregnancy (CSP) because treatment efficacy, safety, and the influence on subsequent pregnancy must be taken into consideration. Here we report our experience with 11 cases of CSP and review the literature regarding subsequent pregnancy. Methods: Records of 11 CSP cases that were treated at our hospital were retrospectively reviewed. CSP was treated by local methotrexate (MTX) injection or laparotomic or laparoscopic removal of the gestational mass and myometrial repair. Outcome of subsequent pregnancy after treatment was followed-up until delivery. Results: Local MTX injection was performed for six cases, laparotomic removal of the gestational mass and myometrial repair was performed for two, and laparoscopic removal of the gestational mass and myometrial repair was performed for three. The uterus was preserved in all cases. After CSP treatment, eight pregnancies occurred in five cases, resulting in six live births and two miscarriages. Conclusion: Advantages and disadvantages of various treatment methods for CSP continue to be elucidated. Serum hCG level, location of the gestational mass, thickness of the lower uterine segment at the time of diagnosis, and whether the patient wishes for fertility preservation should be considered when choosing a treatment plan.展开更多
Cesarean scar ectopic pregnancy is a consequence of a scar from previous cesarean section.It is rare and is associated with catastrophic complications of early pregnancy.It can occur in women with only one prior cesar...Cesarean scar ectopic pregnancy is a consequence of a scar from previous cesarean section.It is rare and is associated with catastrophic complications of early pregnancy.It can occur in women with only one prior cesarean delivery.With increasing rate of cesarean section worldwide,more and more cases are diagnosed and reported.The incidence is likely to rise substantially in the near future.A delay in diagnosis and the treatment can lead to uterine rupture,major haemorrhage,hysterectomy and serious maternal morbidity.Early diagnosis can offer treatment options of avoiding uterine rupture and haemorrhage,thus preserving the uterus and future fertility.Aim of this article is to find the demography,pathophysiology,clinical presentation,most appropriate methods of early diagnosis and management.展开更多
<strong>Background: </strong>The rate of uterus is successfully conserved following the treatment of scar pregnancy which is high so pregnancy outcome following caesarean scar ectopics is getting more and ...<strong>Background: </strong>The rate of uterus is successfully conserved following the treatment of scar pregnancy which is high so pregnancy outcome following caesarean scar ectopics is getting more and more attention. <strong>Objectives: </strong>To assess pregnancy course and outcome after conservative treatment of cesarean scar pregnancy. <strong>Methods:</strong> A retrospective case series of 40 patients become pregnancy after conservative treatment of cesarean scar pregnancy by Foley or Methotrexate and aspiration. Patients in present study were treated at Hung Vuong and Tu Du Hospital between 2015 and 2017. A telephone follow-up was conducted after cesarean scar pregnancy (CSP) treatment. The outcomes of these subsequent pregnancies and mode of delivery were all recorded. <strong>Results:</strong> In 40 pregnancies, there are 22 cases of intrauterine pregnancy with childbirth (55%);all babies were born healthy, with no complications recorded in pregnancy. 12 Women had recurrent scar ectopic (30%). There were 2 abortion cases, 2 cases of ectopic pregnancy, and 2 cases of early miscarriage. <strong>Conclusions:</strong> Our study shows that reproductive outcomes following treatment of caesarean scar ectopic pregnancies are favourable. The risk of recurrent caesarean scar ectopic pregnancy is a concern.展开更多
Objective:To explore appropriate treatment strategy for cesarean scar pregnancy(CSP)in the first and second trimester.Methods:Clinical characteristics and treatment strategies in 182 patients with CSP were retrospecti...Objective:To explore appropriate treatment strategy for cesarean scar pregnancy(CSP)in the first and second trimester.Methods:Clinical characteristics and treatment strategies in 182 patients with CSP were retrospectively analyzed.Treatment strategies were as follows:Group A(n=102),uterine artery chemoembolization(UACE)followed by dilation and curettage(D&C);Group B(n=63),D&C;Group C(n=6),hysteroscopy;Group D(n=6),laparotomy;and Group E(n=5),laparoscopy.The basic clinical findings were collected and analyzed,along with the curative effects.Results:The preoperative serum beta-human chorionic gonadotropin(β-HCG)level was in the order of Group D,A>B,C>E(P=0.001);the size of gestational sac(GS)was in the order of Group D,E>A,C>B(P=0.000);and the thickness of the anterior myometrium was in the order of Group B>A,C>D,E(P=0.000).Three cases in the second trimester were all in Group D;two cases were treated with UACE before laparotomy with moderate blood loss(100 and 200 mL,respectively)and the third case was initially treated with D&C and had severe hemorrhage.Conclusions:The diameter of GS,thickness of the anterior myometrium,and preoperativeβ-HCG level are important factors for the choice of treatment.UACE combined with D&C is a useful measure for most Type 2 CSP cases in the first trimester.For Type 2 CSP cases in the second trimester,UACE before laparotomy could be a reasonable choice.展开更多
To editor:Cesarean scar pregnancy(CSP)is a rare pathology,with an increasingly clear association with morbidly adherent placenta(MAP).1 Although the most recommended treatment is pregnancy termination by cesarean sect...To editor:Cesarean scar pregnancy(CSP)is a rare pathology,with an increasingly clear association with morbidly adherent placenta(MAP).1 Although the most recommended treatment is pregnancy termination by cesarean section and scar resection shortly after diagnosis.2 The final decision regarding management depends on the patient's choice,medical advice,the fertility desire,and the social,religious and emotional background that should also be taken into account.展开更多
Objective: To evaluate the efficacy and safety of uterine artery embolization(UAE) combined with dilation and curettage(D&C) using ultrasound as a treatment for cesarean scar pregnancy(CSP) and assess its effect o...Objective: To evaluate the efficacy and safety of uterine artery embolization(UAE) combined with dilation and curettage(D&C) using ultrasound as a treatment for cesarean scar pregnancy(CSP) and assess its effect on ovarian and reproductive function.Methods: A total of 54 patients with uterine CSP between January 2011 and December 2015 were included in this retrospective study. The patients were treated with UAE combined with D&C using ultrasound for the treatment of CSP and followed up for 5–8 years. Their medical records, medical histories, clinical manifestations, treatment courses, and treatment results were analyzed.Results: The 54 patients were initially treated without severe complications. β-Human chorionic gonadotropin(β-hCG) normalization took 36.11 ± 10.73 days(range, 25–84 days), length of hospitalization was 6.6 ± 1.5 days(range, 4–10 days), and total blood loss was 18.48 ± 8.41 mL(range, 5–33 mL). All patients resumed normal menstruation after 33.48 ± 8.71 days(range, 26–70 days). At the 5–8-year follow-up after UAE combined with D&C by ultrasound for the treatment of uterine CSP, the menstrual volume in 32(59.3%) patients decreased versus before the operation. Compared with pretreatment, the menstrual cycle was prolonged in two(3.7%) cases,shortened in 10(18.5%) cases, irregular in one(1.9%) case, and unchanged in 39(72.2%) cases. Three patients conceived naturally and successfully gave birth to healthy children. Seven(12.96%) patients with accidental natural pregnancies chose induced abortion with no significant change in their sex lives.Conclusion: UAE combined with D&C using ultrasound for the treatment of uterine CSP is safe and effective and may not affect the fertility of patients aged <40 years. However, menstrual volume may be reduced in some patients.展开更多
基金Supported by Medical Health Science and Technology Project of Zhejiang Province,China,No.2020ZH003。
文摘BACKGROUND Cesarean scar pregnancy(CSP)is rare but may result in uterine rupture during pregnancy or massive hemorrhage during abortion procedures.Awareness of this condition is increasing,and most patients with CSP are now diagnosed early and can be managed safely.However,some atypical patients are misdiagnosed,and their surgical risks are underestimated,increasing the risk of fatal hemorrhage.CASE SUMMARY A 27-year-old Asian woman visited our institution because of abnormal pregnancy,and she was diagnosed with a hydatidiform mole through transvaginal ultrasound(TVS).Under hysteroscopy,a large amount of placental tissue was found in the scar of the lower uterine segment,and a sudden massive hemorrhage occurred during the removal process.The bilateral internal iliac arteries were temporarily blocked under laparoscopy,and scar resection and repair were rapidly performed.She was discharged in good condition 5 d after the operation.CONCLUSION Although TVS is widely used in the diagnosis of CSP,delays in the diagnosis of atypical CSP remain.Surgical treatment following internal iliac artery temporary occlusion may be an appropriate management method for unanticipated massive hemorrhage during CSP surgery.
文摘Objective:This paper aims to summarize the operative nursing coordination essentials of type III cesareans car pregnancy removal.Methods:Six patients were recruited for this study,and the patient’s condition was fully evaluated before the operation.In addition,the personnel,environment,and materials were well prepared before the operation,and the preparation of special intraoperative instruments and equipment was perfected.Results:The operation is successfully performed in all six patients.Each surgery lasted 70 to 120 minutes with an average duration of 90 minutes.Postoperative blood loss was about 100-500 ml.Postoperative recovery was good without complications in all the patients.Conclusion:In summary,laparoscopic removal of gestational tissue from type III cesareans car pregnancy in conjunction with hysteroscopy ensures compete removal of gestational tissue,while avoiding damaging the surrounding organs and tissues,thus greatly avoiding common complications which usually occur during the surgery.Effective surgical coordination is helpful to further improve the success rate of the operation.
文摘Background: There is no consensus regarding the optimal treatment for cesarean scar pregnancy (CSP) because treatment efficacy, safety, and the influence on subsequent pregnancy must be taken into consideration. Here we report our experience with 11 cases of CSP and review the literature regarding subsequent pregnancy. Methods: Records of 11 CSP cases that were treated at our hospital were retrospectively reviewed. CSP was treated by local methotrexate (MTX) injection or laparotomic or laparoscopic removal of the gestational mass and myometrial repair. Outcome of subsequent pregnancy after treatment was followed-up until delivery. Results: Local MTX injection was performed for six cases, laparotomic removal of the gestational mass and myometrial repair was performed for two, and laparoscopic removal of the gestational mass and myometrial repair was performed for three. The uterus was preserved in all cases. After CSP treatment, eight pregnancies occurred in five cases, resulting in six live births and two miscarriages. Conclusion: Advantages and disadvantages of various treatment methods for CSP continue to be elucidated. Serum hCG level, location of the gestational mass, thickness of the lower uterine segment at the time of diagnosis, and whether the patient wishes for fertility preservation should be considered when choosing a treatment plan.
文摘Cesarean scar ectopic pregnancy is a consequence of a scar from previous cesarean section.It is rare and is associated with catastrophic complications of early pregnancy.It can occur in women with only one prior cesarean delivery.With increasing rate of cesarean section worldwide,more and more cases are diagnosed and reported.The incidence is likely to rise substantially in the near future.A delay in diagnosis and the treatment can lead to uterine rupture,major haemorrhage,hysterectomy and serious maternal morbidity.Early diagnosis can offer treatment options of avoiding uterine rupture and haemorrhage,thus preserving the uterus and future fertility.Aim of this article is to find the demography,pathophysiology,clinical presentation,most appropriate methods of early diagnosis and management.
文摘<strong>Background: </strong>The rate of uterus is successfully conserved following the treatment of scar pregnancy which is high so pregnancy outcome following caesarean scar ectopics is getting more and more attention. <strong>Objectives: </strong>To assess pregnancy course and outcome after conservative treatment of cesarean scar pregnancy. <strong>Methods:</strong> A retrospective case series of 40 patients become pregnancy after conservative treatment of cesarean scar pregnancy by Foley or Methotrexate and aspiration. Patients in present study were treated at Hung Vuong and Tu Du Hospital between 2015 and 2017. A telephone follow-up was conducted after cesarean scar pregnancy (CSP) treatment. The outcomes of these subsequent pregnancies and mode of delivery were all recorded. <strong>Results:</strong> In 40 pregnancies, there are 22 cases of intrauterine pregnancy with childbirth (55%);all babies were born healthy, with no complications recorded in pregnancy. 12 Women had recurrent scar ectopic (30%). There were 2 abortion cases, 2 cases of ectopic pregnancy, and 2 cases of early miscarriage. <strong>Conclusions:</strong> Our study shows that reproductive outcomes following treatment of caesarean scar ectopic pregnancies are favourable. The risk of recurrent caesarean scar ectopic pregnancy is a concern.
文摘Objective:To explore appropriate treatment strategy for cesarean scar pregnancy(CSP)in the first and second trimester.Methods:Clinical characteristics and treatment strategies in 182 patients with CSP were retrospectively analyzed.Treatment strategies were as follows:Group A(n=102),uterine artery chemoembolization(UACE)followed by dilation and curettage(D&C);Group B(n=63),D&C;Group C(n=6),hysteroscopy;Group D(n=6),laparotomy;and Group E(n=5),laparoscopy.The basic clinical findings were collected and analyzed,along with the curative effects.Results:The preoperative serum beta-human chorionic gonadotropin(β-HCG)level was in the order of Group D,A>B,C>E(P=0.001);the size of gestational sac(GS)was in the order of Group D,E>A,C>B(P=0.000);and the thickness of the anterior myometrium was in the order of Group B>A,C>D,E(P=0.000).Three cases in the second trimester were all in Group D;two cases were treated with UACE before laparotomy with moderate blood loss(100 and 200 mL,respectively)and the third case was initially treated with D&C and had severe hemorrhage.Conclusions:The diameter of GS,thickness of the anterior myometrium,and preoperativeβ-HCG level are important factors for the choice of treatment.UACE combined with D&C is a useful measure for most Type 2 CSP cases in the first trimester.For Type 2 CSP cases in the second trimester,UACE before laparotomy could be a reasonable choice.
文摘To editor:Cesarean scar pregnancy(CSP)is a rare pathology,with an increasingly clear association with morbidly adherent placenta(MAP).1 Although the most recommended treatment is pregnancy termination by cesarean section and scar resection shortly after diagnosis.2 The final decision regarding management depends on the patient's choice,medical advice,the fertility desire,and the social,religious and emotional background that should also be taken into account.
文摘Objective: To evaluate the efficacy and safety of uterine artery embolization(UAE) combined with dilation and curettage(D&C) using ultrasound as a treatment for cesarean scar pregnancy(CSP) and assess its effect on ovarian and reproductive function.Methods: A total of 54 patients with uterine CSP between January 2011 and December 2015 were included in this retrospective study. The patients were treated with UAE combined with D&C using ultrasound for the treatment of CSP and followed up for 5–8 years. Their medical records, medical histories, clinical manifestations, treatment courses, and treatment results were analyzed.Results: The 54 patients were initially treated without severe complications. β-Human chorionic gonadotropin(β-hCG) normalization took 36.11 ± 10.73 days(range, 25–84 days), length of hospitalization was 6.6 ± 1.5 days(range, 4–10 days), and total blood loss was 18.48 ± 8.41 mL(range, 5–33 mL). All patients resumed normal menstruation after 33.48 ± 8.71 days(range, 26–70 days). At the 5–8-year follow-up after UAE combined with D&C by ultrasound for the treatment of uterine CSP, the menstrual volume in 32(59.3%) patients decreased versus before the operation. Compared with pretreatment, the menstrual cycle was prolonged in two(3.7%) cases,shortened in 10(18.5%) cases, irregular in one(1.9%) case, and unchanged in 39(72.2%) cases. Three patients conceived naturally and successfully gave birth to healthy children. Seven(12.96%) patients with accidental natural pregnancies chose induced abortion with no significant change in their sex lives.Conclusion: UAE combined with D&C using ultrasound for the treatment of uterine CSP is safe and effective and may not affect the fertility of patients aged <40 years. However, menstrual volume may be reduced in some patients.
