摘要
剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)治疗后有生育意愿患者中自然妊娠概率约为73%~87.5%;继发不孕概率约为12.5%~14.3%,继发不孕的原因可能为宫腔粘连、子宫动脉栓塞术、剖宫产瘢痕憩室、剖宫产后慢性盆腔炎症、医源性子宫腺肌病和后位子宫。CSP治疗后再次妊娠结局可能为自然流产、复发性瘢痕妊娠(recurrent cesarean scar pregnancy,RCSP)及正常宫内妊娠。RCSP早期发现、及时治疗可避免严重并发症。正常宫内妊娠可能并发胎盘粘连、胎盘植入和前置胎盘,妊娠晚期有子宫破裂可能,多以择期剖宫产终止妊娠。对于仍有生育需求的CSP患者,应选择合适的治疗方式并考虑治疗后妊娠的最佳时机及可能发生的妊娠结局,告知后续妊娠相关风险,妊娠期间严密监测及随访;对于治疗后无生育需求的患者,建议采用安全、长期、可靠的避孕方式。
The natural pregnancy probability of patients with fertility intention after cesarean scar pregnancy(CSP)is about 73%to 87.5%;the secondary infertility probability is about 12.5%to 14.3%.The reasons for secondary infertility may be intrauterine adhesions,uterine arterial embolization,scar diverticula of cesarean section,chronic pelvic inflammation after cesarean section,iatrogenic adenomyosis and posterior uterus.The reproductive pregnancy outcomes following treatment of CSP included spontaneous abortion,recurrent cesarean scar pregnancy(RCSP)and normal intrauterine pregnancy.Early detection and timely treatment of RCSP can avoid serious complications.Placental adhesion,placental implantation,placenta previa are serious complications that may arise in subsequent intrauterine pregnancies.Uterine rupture may occur in the third trimester,and termination of pregnancy with elective cesarean section is needed.For CSP patients who still have fertility needs,they should be given the appropriate treatment.Doctors should consider the best time for pregnancy after treatment and the possible pregnancy outcomes,informing them the subsequent pregnancy-related risks,and closely monitor them and follow-up during pregnancy;For patients without fertility needs after treatment,a safe,long-term,and reliable contraceptive method is recommended.
作者
张新悦
王丹丹
杨清(审校)
ZHANG Xin-yue;WANG Dan-dan;YANG Qing(Shengjing Hospital Affiliated to China Medical University,Shenyang 110001,China)
出处
《国际妇产科学杂志》
CAS
2020年第3期245-248,共4页
Journal of International Obstetrics and Gynecology
基金
2017年辽宁省科学事业公益研究基金资助项目(20170017)
2017年度中国医科大学附属盛京医院“盛京自由研究者”计划(201704)。
关键词
剖宫产术
瘢痕
妊娠
不育
女(雌)性
避孕
妊娠结局
治疗
Cesarean section
Cicatrix
Pregnancy
Infertility,female
Contraception
Pregnancy outcome
Therapy
