Objective: To observe the clinical outcomes of continued pregnancy in pregnant women with cesarean scar pregnancy (CSP). Methods: A retrospective analysis was performed on the pregnancy outcomes of 55 pregnant women who were diagnosed with CSP at the Second Affiliated Hospital of Army Medical University during the first trimester of pregnancy from August 1st, 2018 to October 31st, 2021 and strongly requested to continue the pregnancy. Results: Of the 55 pregnant women, 15 terminated the pregnancy in the first trimester, 1 underwent hysterotomy at 23 weeks of gestation due to cervical dilation, and 39 (71%, 39/55) continued pregnancy to the third trimester achieving live births via cesarean section. The gestational age of the 39 pregnant women delivered by cesarean section was 35+6 weeks (range: 28+5-39+2 weeks), of whom 7 cases at 28+5-33+6 weeks, 20 cases at 34-36+6 weeks, and 12 cases at 37-39+2 weeks. The results of pathological examination were normal placenta in 3 cases (8%, 3/39), placenta creta in 4 cases (10%, 4/39), placenta increta in 9 cases (23%, 9/39) and placenta percreta in 23 cases (59%, 23/39). Among the 36 pregnant women who were pathologically confirmed as placenta accreta spectrum disorders (PAS) after surgery, the last prenatal ultrasonography showed placenta previa in 27 cases (75%, 27/36) and not observed placenta previa in 9 cases. The median intraoperative blood loss, autologous blood transfusion, and allogeneic suspended red blood cell infusion of 39 pregnant women during cesarean section were 1 000 ml (300-3 500 ml), 300 ml (0-2 000 ml) and 400 ml (0-2 400 ml), respectively. The uterine preservation rate was 100% (39/39), and only 1 case received cystostomy due to intracystic hemorrhage. The birth weight of the newborn was 2 580 g (1 350-3 800 g), and 1 case of mild asphyxia. Conclusions: Pregnant women with CSP who continue pregnancy under close monitoring after adequate ultrasound evaluation and doctor-patient communication could achieve better maternal and infant outcomes, but pregnant women with CSP are highly likely to continue pregnancy and develop into PAS. Effective hemostasis means and multidisciplinary team cooperation are needed in perinatal period for ensuring maternal and fetal safety.
目的： 观察剖宫产术后子宫瘢痕妊娠（CSP）孕妇继续妊娠的临床结局。 方法： 回顾性分析2018年8月1日至2021年10月31日妊娠早期于陆军军医大学第二附属医院诊断为CSP并强烈要求继续妊娠的55例孕妇的妊娠结局。 结果： 55例孕妇中，15例（27%，15/55）于妊娠早期终止妊娠，1例因子宫颈管扩张于孕23周行剖宫取胎术，39例（71%，39/55）继续妊娠至妊娠晚期行剖宫产术获得活产儿。39例剖宫产术分娩孕妇的中位分娩孕周为35+6周（范围：28+5~39+2周），其中，孕28+5~33+6周分娩7例，孕34~36+6周分娩20例，孕37~39+2周分娩12例；病理检查结果为胎盘正常3例（8%，3/39），粘连型胎盘植入4例（10%，4/39），植入型胎盘植入9例（23%，9/39），穿透型胎盘植入23例（59%，23/39）。36例术后病理证实为胎盘植入性疾病（PAS）的孕妇中，产前最后一次超声检查提示为前置胎盘者27例（75%，27/36），9例未提示合并前置胎盘。39例剖宫产术分娩孕妇的中位术中出血量1 000 ml（范围：300~3 500 ml），中位自体血回输量300 ml（范围：0~2 000 ml），输注异体悬浮红细胞400 ml（范围：0~2 400 ml）；产妇子宫保留率100%（39/39），仅1例因术中发生膀胱内出血行膀胱造瘘术；中位新生儿出生体重2 580 g（范围：1 350~3 800 g），仅1例新生儿轻度窒息。 结论： CSP孕妇经充分超声评估及医患沟通后、在严密监护下继续妊娠可以获得较好的母儿结局，但CSP孕妇继续妊娠发展为PAS的可能性极大，围产期需要有效的止血手段及多学科团队协作以保障母儿安全。.