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目的探讨剖宫产术后子宫瘢痕处妊娠(CSP)的临床特点和诊治方法。方法对本院2010年1月至2012年12月收治的10例CSP的临床资料进行回顾性分析。结果 6例患者因终止妊娠前未能及时诊断为CSP,治疗过程出现大出血,后及时改为子宫动脉栓塞+MTX(甲氨蝶呤)治疗,有效控制出血;4例患者终止妊娠前诊断为CSP,采用子宫动脉栓塞+MTX治疗,后行清宫术,治疗过程中出血少。10例患者治愈出院,全部保留子宫。结论 CSP的发生率有所上升,采用子宫动脉栓塞+MTX治疗是安全有效,出血少,并能保留子宫。对于有剖宫产史的妊娠患者,终止妊娠前应行B超检查排除CSP,防止盲目清宫引起大出血。
Objective To investigate the clinical features and diagnosis and treatment of pregnancy after cesarean section (CSP). Methods The clinical data of 10 cases of CSP admitted from January 2010 to December 2012 in our hospital were analyzed retrospectively. Results Six patients were diagnosed as CSP before the termination of pregnancy. Bleeding occurred in the course of treatment and promptly replaced by uterine arterial embolization + MTX (methotrexate) to effectively control the bleeding. Four patients were diagnosed as CSP before termination of pregnancy , The use of uterine artery embolization + MTX treatment, after radical curettage, bleeding during treatment less. Ten patients were cured, all retained the uterus. Conclusions The incidence of CSP has risen. Uterine artery embolization + MTX is safe and effective, with less bleeding and can retain the uterus. For pregnant women with a history of cesarean section, before the termination of pregnancy B-ultrasound should be ruled out to exclude CSP, to prevent blind bleeding caused by massive bleeding.