剖宫产瘢痕妊娠目前诊治进展

Caesarean Scar Pregnancy: Current Diagnosis and Treatment Progress

摘要: 近年来，剖宫产瘢痕处妊娠(CSP)发生率在异位妊娠中占比例有升高，这与既往20年全世界较高的剖宫产率和成像技术的进步有关，尽管近5年来全世界尤其是中国剖宫产率明显下降，但2013年我国二孩政策开放，很多既往有剖宫产史的育龄期女性有再次生育愿望，CSP发生率也呈上升趋势。其早期临床表现缺乏特异性，极易被误诊为先兆流产等，如果没有对其进行及时有效的治疗，或缺乏恰当的终止妊娠方式，会对患者的生命安全造成严重威胁。因此，早期认识和及时管理对于优化治疗和改善患者结局至关重要，对于这种具有潜在致命性疾病，一旦确定，多建议早期终止妊娠。迄今为止，全球对于CSP尚无标准治疗方式，剖宫产瘢痕妊娠治疗的主要目的是保持生育能力及预防危急生命的大出血，以保持受影响妇女的健康状况、生活质量和未来生育能力。本文将近年来瘢痕处妊娠诊断治疗进展进行综述。

Abstract: In recent years, the incidence of cesarean scar pregnancy (CSP) in ectopic pregnancy has a higher percentage because of high cesarean section rate and the progress of imaging technology over the past 20 years in the world. Although in the past five years, the cesarean section rate dropped sig-nificantly in the world, especially in China, because China’s second-child policy was adopted in 2013, many women who have a history of cesarean section have fertility desire again, the incidence of CSP is also on the rise. CSP early clinical manifestations are lack of specificity, can easily be misdiagnosed as threatened abortion, etc., if there is no timely and effective treatment for it, or the lack of appropriate termination of pregnancy, it will pose a serious threat to the life safety of patients. Therefore, early recognition and timely management are crucial to optimize treatment and improve patient outcomes. For this potentially fatal disease, early termination of pregnancy is often recommended once it is identified. Up to now, there is no standard treatment for CSP in the world. The main purpose of cesarean scar pregnancy treatment is to maintain fertility and prevent life-threatening bleeding, so as to maintain the health status, quality of life and future fertility of the affected women. This article reviews the progress of diagnosis and treatment of scar pregnancy in recent years.