Society for Maternal-Fetal Medicine (SMFM) Consult Series #49: Cesarean scar pregnancy
Society for Maternal-Fetal Medicine (SMFM) Consult Series #49: Cesarean scar pregnancy
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DOI：
10.1016/j.ajog.2020.01.030
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发表时间：
2020-05-01
影响因子：
9.8
通讯作者：
Gyamfi-Bannerman, Cynthia
中科院分区：
文献类型：
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作者：
Miller, Russell;Timor-Tritsch, Ilan E.;Gyamfi-Bannerman, Cynthia
剖腹产疤痕妊娠是一种并发症，早期妊娠植入之前剖腹产的疤痕中。这种情况带来了严重的孕产妇发病率的巨大风险，因为在确保及时诊断方面存在挑战，以及一旦确定最佳治疗的不确定性。超声是剖宫产瘢痕妊娠诊断的主要影像学方式，尽管准确及时的确定是困难的。手术，药物和微创治疗已被描述为剖宫产瘢痕妊娠的管理，但最佳的治疗方法是未知的。对于拒绝接受剖宫产瘢痕妊娠治疗的妇女，应告知其严重发病的风险。以下是母胎医学协会的建议：我们建议不要对剖宫产瘢痕妊娠进行期待治疗（1B级）;我们建议手术切除剖宫产瘢痕妊娠的手术治疗应考虑经阴道或腹腔镜途径（如可能）或超声引导下真空抽吸，避免单纯的尖锐刮除（2C级）;我们建议妊娠期甲氨蝶呤用于剖宫产瘢痕妊娠的药物治疗，伴或不伴其他治疗方式（2C级）;我们建议不要单独使用全身甲氨蝶呤治疗剖宫产瘢痕妊娠（1C级）;在选择期待治疗和继续剖宫产瘢痕妊娠的妇女中，我们建议在妊娠34 0/7和35 6/7周之间重复剖宫产（1C级）;我们建议剖宫产瘢痕妊娠的女性应告知再次妊娠的风险，并咨询有效的避孕方法，包括长效可逆避孕和永久避孕（1C级）。
Cesarean scar pregnancy is a complication in which an early pregnancy implants in the scar from a prior cesarean delivery. This condition presents a substantial risk for severe maternal morbidity because of challenges in securing a prompt diagnosis, as well as uncertainty regarding optimal treatment once identified. Ultrasound is the primary imaging modality for cesarean scar pregnancy diagnosis, although a correct and timely determination can be difficult. Surgical, medical, and minimally invasive therapies have been described for cesarean scar pregnancy management, but the optimal treatment is not known. Women who decline treatment of a cesarean scar pregnancy should be counseled regarding the risk for severe morbidity. The following are Society for Maternal-Fetal Medicine recommendations: We recommend against expectant management of cesarean scar pregnancy (GRADE 1B); we suggest operative resection (with transvaginal or laparoscopic approaches when possible) or ultrasound-guided vacuum aspiration be considered for surgical management of cesarean scar pregnancy and that sharp curettage alone be avoided (GRADE 2C); we suggest intragestational methotrexate for medical treatment of cesarean scar pregnancy, with or without other treatment modalities (GRADE 2C); we recommend that systemic methotrexate alone not be used to treat cesarean scar pregnancy (GRADE 1C); in women who choose expectant management and continuation of a cesarean scar pregnancy, we recommend repeat cesarean delivery between 34 0/7 and 35 6/7 weeks of gestation (GRADE 1C); we recommend that women with a cesarean scar pregnancy be advised of the risks of another pregnancy and counseled regarding effective contraceptive methods, including long-acting reversible contraception and permanent contraception (GRADE 1C).