Abstract：
To evaluate Cesarean scar defects using saline contrast sonohysterography (SCSH) in women with a history of Cesarean scar pregnancy (CSP).
A cohort of 38 non-pregnant women with a history of CSP treated with combined local and systemic methotrexate was investigated prospectively by SCSH. For the purpose of analysis, they were classified, according to the modified Delphi consensus criteria for CSP in early gestation, into three subgroups based on the depth of the gestational sac herniation in the midsagittal plane. Subgroup A included eight (21.1%) cases, in which the largest part of the gestational sac protruded towards the uterine cavity; Subgroup B included 20 (52.6%) cases, in which the largest part of the gestational sac was embedded in the myometrium; and Subgroup C included 10 (26.3%) cases, in which the gestational sac was located partially outside the outer contour of the cervix or uterus.
SCSH revealed that all women in Subgroup C had a uterine niche. The median niche length (P = 0.006) and depth (P = 0.015) were significantly greater in Subgroup C than in Subgroups A or B. The median residual myometrial thickness (RMT) was significantly lower in Subgroup C than in Subgroups A or B (P = 0.006).
Women with prior CSP who had a gestational sac protruding beyond the serosal line had a significantly greater niche length and depth, and lower RMT. This knowledge may guide individualized risk counseling. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
A cohort of 38 non-pregnant women with a history of CSP treated with combined local and systemic methotrexate was investigated prospectively by SCSH. For the purpose of analysis, they were classified, according to the modified Delphi consensus criteria for CSP in early gestation, into three subgroups based on the depth of the gestational sac herniation in the midsagittal plane. Subgroup A included eight (21.1%) cases, in which the largest part of the gestational sac protruded towards the uterine cavity; Subgroup B included 20 (52.6%) cases, in which the largest part of the gestational sac was embedded in the myometrium; and Subgroup C included 10 (26.3%) cases, in which the gestational sac was located partially outside the outer contour of the cervix or uterus.
SCSH revealed that all women in Subgroup C had a uterine niche. The median niche length (P = 0.006) and depth (P = 0.015) were significantly greater in Subgroup C than in Subgroups A or B. The median residual myometrial thickness (RMT) was significantly lower in Subgroup C than in Subgroups A or B (P = 0.006).
Women with prior CSP who had a gestational sac protruding beyond the serosal line had a significantly greater niche length and depth, and lower RMT. This knowledge may guide individualized risk counseling. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
摘要：
目的：使用盐水超声造影（SCSH）评估有剖宫产瘢痕妊娠（CSP）病史的妇女的剖宫产瘢痕缺陷。
方法：通过SCSH前瞻性调查了38名非妊娠妇女，这些妇女有CSP病史，接受局部和全身甲氨蝶呤联合治疗。为了分析的目的，他们被分类了，根据改良的Delphi妊娠早期CSP共识标准，根据孕囊疝在矢状面的深度分为三个亚组。A亚组包括8例（21.1％），其中孕囊的最大部分向子宫腔突出；B亚组包括20例（52.6％），其中孕囊的最大部分嵌入子宫肌层；C亚组包括10例（26.3％），其中孕囊部分位于子宫颈或子宫外轮廓之外。
结果：SCSH显示C亚组的所有女性都有子宫壁龛。C亚组的中位生态位长度（P=0.006）和深度（P=0.015）明显大于A或B亚组。C亚组的中位残余肌层厚度（RMT）明显低于A或B亚组（P=0.006）。
结论：妊娠囊突出超过浆膜线的既往CSP妇女的生态位长度和深度明显更大，和较低的RMT。这些知识可以指导个性化的风险咨询。©2023国际妇产科超声学会。
方法：通过SCSH前瞻性调查了38名非妊娠妇女，这些妇女有CSP病史，接受局部和全身甲氨蝶呤联合治疗。为了分析的目的，他们被分类了，根据改良的Delphi妊娠早期CSP共识标准，根据孕囊疝在矢状面的深度分为三个亚组。A亚组包括8例（21.1％），其中孕囊的最大部分向子宫腔突出；B亚组包括20例（52.6％），其中孕囊的最大部分嵌入子宫肌层；C亚组包括10例（26.3％），其中孕囊部分位于子宫颈或子宫外轮廓之外。
结果：SCSH显示C亚组的所有女性都有子宫壁龛。C亚组的中位生态位长度（P=0.006）和深度（P=0.015）明显大于A或B亚组。C亚组的中位残余肌层厚度（RMT）明显低于A或B亚组（P=0.006）。
结论：妊娠囊突出超过浆膜线的既往CSP妇女的生态位长度和深度明显更大，和较低的RMT。这些知识可以指导个性化的风险咨询。©2023国际妇产科超声学会。
