Abstract：
OBJECTIVE: Clinical evaluation of the new Delphi consensus definition of cesarean scar pregnancy (CSP) in early gestation.
METHODS: A retrospective cohort of 36 women diagnosed with CSP and treated with combined local and systemic methotrexate (MTX) between 2008 and 2021. The CSPs were classified according to the new Delphi consensus criteria into three subgroups based on the depth of the gestational sac herniation in the sagittal plane. Subgroup A included 8 (22.2%) cases in which the largest part of the gestational sac protruded toward the uterine cavity. Subgroup B included 22 (61.1%) cases in which the largest part of the gestational sac was embedded in the myometrium, and subgroup C included 6 (16.7%) cases in which the gestational was partially located outside the outer contour of the cervix or uterus.
RESULTS: The β-HCG level upon admission was significantly lower in subgroup A than in subgroups B or C (11,075 ± 7109, 18,787 ± 16,585, and 58,273 ± 55,267 mIU/mL, respectively, P = .01). All subgroup C patients had repeated courses of MTX and surgical interventions (laparotomy, uterine artery embolization, and operative hysteroscopy) at double the rate of subgroups A or B (100, 50, and 40.9%, respectively, P = .036). The duration of hospitalization was significantly shorter in subgroup A than in subgroups B or C (1.9 ± 1.5, 2.1 ± 1.1, and 5.4 ± 4.9 days, P = .01).
CONCLUSIONS: The outcome according to Delphi consensus criteria for defining CSP in early gestation has implications for clinical decision-making, patient care, and the follow-up of CSP.
METHODS: A retrospective cohort of 36 women diagnosed with CSP and treated with combined local and systemic methotrexate (MTX) between 2008 and 2021. The CSPs were classified according to the new Delphi consensus criteria into three subgroups based on the depth of the gestational sac herniation in the sagittal plane. Subgroup A included 8 (22.2%) cases in which the largest part of the gestational sac protruded toward the uterine cavity. Subgroup B included 22 (61.1%) cases in which the largest part of the gestational sac was embedded in the myometrium, and subgroup C included 6 (16.7%) cases in which the gestational was partially located outside the outer contour of the cervix or uterus.
RESULTS: The β-HCG level upon admission was significantly lower in subgroup A than in subgroups B or C (11,075 ± 7109, 18,787 ± 16,585, and 58,273 ± 55,267 mIU/mL, respectively, P = .01). All subgroup C patients had repeated courses of MTX and surgical interventions (laparotomy, uterine artery embolization, and operative hysteroscopy) at double the rate of subgroups A or B (100, 50, and 40.9%, respectively, P = .036). The duration of hospitalization was significantly shorter in subgroup A than in subgroups B or C (1.9 ± 1.5, 2.1 ± 1.1, and 5.4 ± 4.9 days, P = .01).
CONCLUSIONS: The outcome according to Delphi consensus criteria for defining CSP in early gestation has implications for clinical decision-making, patient care, and the follow-up of CSP.
摘要：
目的：对早期妊娠剖宫产瘢痕妊娠（CSP）的新Delphi共识定义进行临床评估。
方法：2008年至2021年期间，对36名诊断为CSP并接受局部和全身甲氨蝶呤（MTX）联合治疗的女性进行回顾性队列研究。根据新的Delphi共识标准，根据矢状面的孕囊疝深度将CSP分为三个亚组。A亚组包括8例（22.2％），其中孕囊的最大部分向子宫腔突出。B亚组包括22例（61.1％），其中孕囊的最大部分嵌入子宫肌层，C亚组包括6例（16.7％），其中妊娠部分位于子宫颈或子宫外轮廓之外。
结果：A亚组入院时β-HCG水平明显低于B或C亚组（11,075±7109，18,787±16,585和58,273±55,267mIU/mL，分别,P=0.01）。所有C亚组患者都有重复的MTX疗程和手术干预（剖腹手术，子宫动脉栓塞术,和手术宫腔镜检查）的发生率是A或B亚组的两倍（100、50和40.9％，分别,P=.036）。A亚组住院时间明显短于B或C亚组(1.9±1.5,2.1±1.1,5.4±4.9天,P=0.01）。
结论：根据Delphi共识标准定义妊娠早期CSP的结果对临床决策具有重要意义。病人护理,以及CSP的后续行动。
方法：2008年至2021年期间，对36名诊断为CSP并接受局部和全身甲氨蝶呤（MTX）联合治疗的女性进行回顾性队列研究。根据新的Delphi共识标准，根据矢状面的孕囊疝深度将CSP分为三个亚组。A亚组包括8例（22.2％），其中孕囊的最大部分向子宫腔突出。B亚组包括22例（61.1％），其中孕囊的最大部分嵌入子宫肌层，C亚组包括6例（16.7％），其中妊娠部分位于子宫颈或子宫外轮廓之外。
结果：A亚组入院时β-HCG水平明显低于B或C亚组（11,075±7109，18,787±16,585和58,273±55,267mIU/mL，分别,P=0.01）。所有C亚组患者都有重复的MTX疗程和手术干预（剖腹手术，子宫动脉栓塞术,和手术宫腔镜检查）的发生率是A或B亚组的两倍（100、50和40.9％，分别,P=.036）。A亚组住院时间明显短于B或C亚组(1.9±1.5,2.1±1.1,5.4±4.9天,P=0.01）。
结论：根据Delphi共识标准定义妊娠早期CSP的结果对临床决策具有重要意义。病人护理,以及CSP的后续行动。
