ABSTRACT
Objective:
To study the
risk factors of adverse
pregnancy outcomes for
induced abortion of cesarean
scar pregnancy in
midtrimester.
Methods:
A national multicenter
retrospective study was conducted. A total of 154 singletons
pregnant women with cesarean
scar pregnancy during the
second trimester induced abortion by various reasons in 12 tertiary A
hospitals were selected, their pregnant outcomes were observed and the
risk factors of serious adverse outcomes were analyzed with univariate and multivariate logstic regression; the
role of ultrasound and MRI in predicting
placenta accreta and severe adverse outcomes was evaluated, the
effectiveness of
uterine artery embolization (UAE) in preventing
hemorrhage in
pregnant women with and without
placenta accreta was compared.
Results:
Among 154 subjects, the rate of
placenta accreta was 42.2% (65/154), the rate of
postpartum hemorrhage≥1 000 ml was 39.0% (60/154), the rate of
hysterectomy was 14.9% (23/154), the rate of
uterine rupture was 0.6% (1/154). The
risk factor of
postpartum hemorrhage≥1 000 ml and
hysterectomy was
placenta accreta ( P<0.01). For each increase in the number of
parity, the
risk of
placenta accreta increased 2.385 times (95% CI 1.046-5.439; P=0.039); and the
risk of
placenta accreta decreased with increasing ultrasound measurement of
scar myometrium thickness ( OR=0.033, 95% CI 0.001-0.762; P=0.033). The amount of
postpartum hemorrhage and
hysterectomy rate in the group with
placenta accreta diagnosed by ultrasound combined with MRI were not significantly different from those in the group with
placenta accreta diagnosed by ultrasound only or MRI only (all P>0.05). For
pregnant women with
placenta accreta, there were no significant difference in the amount of
bleeding and
hysterectomy rate between the UAE group [median 1 300 ml; 34% (16/47)] and the non-embolization group (all P>0.05); in
pregnant women without
placenta accreta, the amount of
bleeding in the UAE group was lower than that in the non-embolization group (median 100 vs 600 ml; P<0.01), but there was no significant difference in
hysterectomy rate [2% (1/56) vs 9% (3/33); P>0.05].
Conclusions:
(1)
Placenta accreta is the only
risk factor of
postpartum hemorrhage≥1 000 ml with
hysterectomy for
induced abortion of cesarean
scar pregnancy in
midtrimester; multi-
parity and ultrasound measurement of
scar myometrium thickness are
risk factors for
placenta accreta. (2) The
technique of using ultrasound and MRI in predicting
placenta accreta of cesarean
scar pregnancy needs to be improved. (3) It is necessary to discuss of UAE in preventing
postpartum hemorrhage for
induced abortion of cesarean
scar pregnancy in
midtrimester.