Early clinical features and risk factors for cesarean scar pregnancy: a retrospective case-control study

Abstract

The aim of this study was to investigate early clinical features and risk factors for cesarean scar pregnancy (CSP). Study group of 206 CSP patients out of 6853 women with early pregnancies, diagnosed from 2014 to 2016 was compared with a randomly selected control group of 412 patients. Early clinical features for CSP were vaginal bleeding (OR: 9.65; 95% CI: 5.67–16.41), lower abdominal pain (OR: 3.8; 95% CI: 1.52–9.54) and increased white blood cells (OR: 1.30; 95% CI: 1.12–1.50). Important risk factors for CSP were artificial abortion within the last pregnancy (OR: 4.13; 95% CI: 2.23–7.66), 0 ∼ 1 year and 2 ∼ 3 year interval between present and last pregnancy (OR: 2.27; 95% CI: 1.11–4.67 and OR: 2.15; 95% CI: 1.15–4.03). Pregnancy problems are important issues within the scope of ‘Gynecological Endocrinology’. Vaginal bleeding and lower abdominal pain, although unspecific, could be early clinical symptoms of CSP, especially if main risk factors exist such as abortion within the last pregnancy and short interval to the last pregnancy. Knowing this can help for prevention and early diagnosis CSP which can reduce life-threatening complications such as massive hemorrhage and can avoid hysterectomy. Consequence also must be to avoid unwanted pregnancies by using effective contraception, especially in risk patients.

摘要

本研究的目的是探讨剖宫产后瘢痕妊娠（CSP）的早期临床特点及危险因素。从2014年至2016年6853名诊断为早孕妇女中筛选出206名CSP患者作为研究组, 随机选择412名患者作为对照组进行比较。CSP的早期临床特征是阴道出血（OR: 9.65; 95％CI: 5.67-16.41）, 下腹痛（OR: 3.8; 95％CI: 1.52-9.54）和血中白细胞增加（OR: 1.30; 95％CI: 1.12-1.50）。CSP的重要危险因素是上次妊娠期的人工流产（OR: 4.13; 95％CI: 2.23-7.66）, 本次和上次妊娠的间隔时间0∼1年和2∼3年（OR: 2.27; 95％CI: 1.11-4.67和OR: 2.15; 95％CI: 1.15-4.03）。妊娠问题是“妇科内分泌学”范畴内的重要问题。阴道出血和下腹痛虽无特异性, 但可能是CSP的早期临床症状, 尤其是如果存在上次妊娠期流产和距离上次妊娠间隔较短等主要危险因素时。了解这一点可以帮助预防和早期诊断CSP, 减少危及生命的并发症发生, 如大出血, 可以避免子宫切除术。还必须通过使用有效的避孕措施避免意外怀孕, 特别是对高危患者。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• Cesarean scar pregnancy
• early clinical features
• risk factors

Disclosure statement

No potential conflict of interest was reported by the authors

Additional information

Funding

This work was supported by Beijing Nature Science Foundation under Grant [7162062], Beijing Municipal Administration of Hospitals, Ascent Plan Project, DFL20181401, Beijing Municipality Health Technology High-level Talent Program under Grant [2014–2-016] and Beijing Municipal Science and Technology Commission, Capital Citizens Health Cultivation Project under Grant [Z131100006813034].