臨床分析 34 例剖腹產疤痕懷孕患者以子宮動脈栓塞合併子宮內膜刮除手術治療之療效

Abstract

Introduction Caesarean scar pregnancy (CSP) is a rare and lethal disorder in the past. Increasing incidence was noted following rising Caesarean section rate in last 2 decades. Early diagnosis can avoid uterine rupture, major hemorrhage, hysterectomy and serious maternal morbidity, which allowed the use of conservative treatments to preserve the uterus. The most appropriate management of CSP is not clear, although several treatment modalities have been proposed. We presented our experiences of CSP treated with dilation and curettage (D&C) after uterine artery embolization (UAE). Method The study was retrospective to review those women who received UAE and D&C for CSP between Jan 2001 and Dec 2009. We excluded those patients who were misdiagnosed as normal early intrauterine pregnancy or inevitable miscarriage before D&C. Gestational age, vaginal bleeding amount during D&C, hemoglobin, and hospitalization time were all recorded. Result 34 women with CSP were managed in our unit. The women’s average age was 34.4± 5.68 years. 44.1% of these patients have undergone multiple (≧2) cesarean sections. The average of blood loss during D&C was 17.1±8.5 ml. The average hospitalization time was 3.56±1.41 days. The uterus was conserved in all cases (100%). Menstruation resumed normal in 29 patients one or two months later. 7 out of the 34 women were pregnant again during follow-up. Three gave birth by C/S in term without any complications. D&C had been performed on two women whom didn’t want more babies and one of them received tubal ligation at same time. The other two patients suffered from ectopic pregnancies. One is right tubal pregnancy, who received laparoscopic surgery. The other is a recurrent CSP and received D & C followed UAE again without complications. Conclusion To treat CSP with UAE and D & C is an effective method. It preserves fertility and has fewer blood loss, complication and hospitalization time. However, recurrent CSP must be attended. Based on the results of this series, we suggest that D & C followed UAE can be used as the primary treatment for CSP.