Research question

What is the best intervention time and method for patients who are diagnosed with heterotopic caesarean scar pregnancy (HCSP) wishing to preserve intrauterine pregnancy.

Design

Four patients diagnosed with HCSP from January 2014 to May 2019 were enrolled. Because HCSP is rare, data on 27 published cases were extracted to augment the analysis. Clinical characteristics and medical documents related to fetal reduction and subsequent maternal–neonate outcomes were analysed.

Results

The intervention time was significantly earlier in the full-term birth group (6.76 ± 1.05 weeks) compared with pre-term birth group (8.02 ± 1.55 weeks; P = 0.042). The cumulative full-term delivery rate was 91.48% when the intervention was at 6 weeks’ gestation and decreased to 42.02% at 8 weeks. The maternal–neonate outcome was similar among the selective fetal reduction and surgical removal groups as was delivery time (34.68 ± 3.12 versus 34.80 ± 6.64 weeks; P = 0.955). In the four cases undergoing selective fetal reduction, the residual mass grew by 1.16–7.07 times compared with the area before reduction. The maximum size of the residual mass was observed at 12–13 weeks and 22–25 weeks.

Conclusions

Most patients with HCSP who choose to keep intrauterine pregnancy will be able to carry the fetus to term. Selective fetal reduction would be the first intervention of choice and should take place immediately after diagnosis. The residual mass after reduction could continue to grow throughout the whole pregnancy, although this should not be considered as an indication for termination. With good supervision and careful management, the pregnancy could be maintained and carried to term.

中文翻译：

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一项回顾性队列研究表明，尽早干预异位剖腹产疤痕妊娠以保持子宫内妊娠可以改善预后。

研究问题

对于诊断为希望保留宫内妊娠的异位剖腹产疤痕妊娠（HCSP）的患者，最佳干预时间和方法是什么？

设计

纳入了2014年1月至2019年5月诊断为HCSP的四名患者。由于HCSP很少，因此提取了27个已发表病例的数据以加强分析。分析了与胎儿减少以及随后的母婴关系有关的临床特征和医学文献。

结果

与早产组（8.02±1.55周；P  = 0.042）相比，足月分娩组（6.76±1.05周）的干预时间明显提前。妊娠6周时的累计足月分娩率为91.48％，而在8周时降至42.02％。在选择性减少胎儿组和手术切除组中，母体-新生儿的结局与分娩时间相似（34.68±3.12对34.80±6.64周；P  = 0.955）。在有选择地进行胎儿复位的四例病例中，残余质量比复位前的面积增加了1.16-7.07倍。在12–13周和22–25周观察到最大残留量。

结论

选择保持子宫内妊娠的大多数HCSP患者将能够将胎儿带到足月。选择性减少胎儿将是首选的干预措施，应在诊断后立即进行。减少后的残留质量可能会在整个怀孕期间继续增长，尽管这不应被视为终止妊娠的指征。在良好的监督和精心的管理下，可以维持妊娠并使其足月。