剖宫产术后瘢痕妊娠患者手术治疗与再次妊娠结局分析OA

Objective To investigate the clinical characteristics of different types of Caesarean scar pregnancy(CSP),compare the efficacy of corresponding surgical treatment approaches,and assess the impact of various treatments on subsequent pregnancy outcomes.Methods A total of 943 CSP patients undergoing surgery at Shengjing Hospital of CMU from Jan.1,2016 to Dec.31,2022 were included and their clinical data were retrospectively analyzed.Patients were classified by 2016 CM A criteria into types Ⅰ,Ⅱ and Ⅲ(mass/non-mass).Clinical differences,surgical outcomes,and risk factors for intraoperative bleeding were compared among the groups.Follow-up was used to assess the subsequent pregnancy outcomes.Statistical methods were adopted to describe the differences in clinical variables.Results Among the 943 CSP patients,type Ⅰ accounted for 38.5％(363 cases),type Ⅱ 41.1％(387 cases),non-mass type Ⅲ 13.1％(124 cases),and mass type Ⅲ 7.3％(69 cases).Significant differences were observed in amenorrhea duration and maximum gestational sac diameter among different types.There were differences in intraoperative blood loss and hospitalization costs among different surgical approaches,with a high overall success rate.In non-mass type Ⅲ patients,amenorrhea duration was an independent influencing factor for the change from TCR±suction curettage to other surgical approaches,while the largest gestational sac diameter was a risk factor for increased blood loss during surgery.Follow-up of 78 patients with subsequent pregnancies revealed 22 cases of CSP.Intraoperative repair of scar myometrium was associated with subsequent pregnancy outcomes,and those without repair had a higher risk.Conclusions TCR±suction curettage is suitable for type Ⅰ and type Ⅱ CSP;for non-mass type Ⅲ CSP,surgical approach should be chosen with caution.IntIraoperative repair of scar myometrium helps to improve subsequent pregnancy outcomes.