剖宫产瘢痕妊娠期待治疗的不良妊娠结局分析  

Adverse Outcome of Cesarean Scar Pregnancy Managed Expectantly

作　　者：韩振艳[1] 张媛[1] 侯红瑛[1] HAN Zhen-yan;ZHANG Yuan;HOU Hong-ying(Department of Obstetrics and Gynecology,the Third Affiliated Hospital of SUN Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院产科

出　　处：《中山大学学报（医学版）》2019年第6期953-960,共8页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广州市科技计划项目(201604020104)

摘　　要：【目的】探讨剖宫产瘢痕妊娠(CSP)与胎盘植入的关系及CSP期待治疗的风险评估。【方法】回顾性分析2014年1月至2018年12月在中山大学附属第三医院就诊并要求期待治疗的3例CSP的自然病程,总结其临床特点、超声表现及其不良妊娠结局。【结果】3例CSP患者既往子宫下段剖宫产次数为1~2次,临床症状包括:反复阴道流血、血尿及剧烈腹痛。3例CSP首次超声诊断CSP的孕周为6+2周、7周及7+4周;超声分型分别为Ⅰ、Ⅱ及Ⅲ型;其首次超声诊断胎盘植入的时间分别为24+4周、12+2周及13+1周,中孕期超声均诊断为穿透性胎盘植入。3例CSP分别因反复大量阴道流血、血尿及膀胱血块填塞及子宫破裂而在中孕期终止妊娠,无活产婴儿;术中均被证实为穿透性胎盘植入,1例行子宫次全切除获得术后病理确诊,出血量均超过2500 mL,无孕产妇死亡。【结论】CSP与胎盘植入的关系密切,在期待治疗的过程中应警惕穿透性胎盘植入。CSP的自然病程常合并严重的不良妊娠结局,不可盲目的选择期待治疗。【Objective】To provide further evidence of the association between cesarean scar pregnancy(CSP)and placenta increta,and to investigate the risk of expectant management of CSP.【Methods】A retrospective review of 3 women diagnosed with CSP,who were managed expectantly,was performed in the Third Affiliated Hospital of SUN Yat-sen University from January 2014 to December 2018.Their clinical characteristics,sonographic manifestation and poor out?comes were analyzed.【Results】These 3 cases of CSP had 1~2 previous lower segment cesarean sections and their clinical symptoms included recurrent hemorrhage,gross hematuria and severe abdominal pain.Among the 3 cases,the gestational age at diagnosis of CSP was 6+2 weeks,7 weeks and 7+4 weeks,respectively;the sonographic CSP type was typeⅠ,typeⅡand typeⅢ,respectively;the gestational age at the first diagnosis of placenta increta was 24+4 weeks,12+2 weeks and 13+1 weeks,respectively;and all 3 cases were diagnosed as placenta percreta by ultrasound at the second trimester.These 3 cases of CSP were terminated at the second trimester without liveborn neonates because of severe hemorrhage,colt tamponade of bladder and uterine rupture;and all were confirmed as placenta percreta during surgery with the total blood loss of more than 2500 mL and without maternal death,and one got a pathological diagnosis of placenta percreta after subtotal hysterectomy.【Conclusion】Placenta percreta should be noticed during the expectant management of CSP because of the close association between CSP and placenta increta.Natural history of CSP is usually associated with adverse outcome,and therefore expectant management of CSP should be carefully chosen.

关 键 词：剖宫产 妊娠 异位 胎盘植入 子宫切除 

分 类 号：R714.25[医药卫生—妇产科学]