ĐẶC ĐIỂM LÂM SÀNG VÀ CẬN LÂM SÀNG CÁC TRƯỜNG HỢP CHỬA TẠI SẸO MỔ LẤY THAI ĐƯỢC ĐIỀU TRỊ BẰNG PHẪU THUẬT TẠI BỆNH VIỆN PHỤ SẢN TRUNG ƯƠNG

Abstract

Objective: Describe the clinical and subclinical characteristics of cesarean scar pregnancy cases treated surgically at the National Hospital of Obstetrics and Gynecology. Method: Retrospective description. Results: A total of 45 cases met the selection criteria of the study. Of which, the average age of the patients was 35,98±5,2 (Max: 46 years old, Min: 25 years old). There were 29/45 cases of cesarean section from 2 times or more (64,4%) and 29/45 cases had previous curettage/vacuum abortion (64,4%). The most common symptom was delayed menstruation in 40/45 cases (88,9%), abnormal vaginal bleeding in 30/45 cases (66,7%) and lower abdominal pain in 8/45 cases (17,8%). The average gestational age was 8,3±1,7 weeks (Max: 12 weeks 3 days, Min: 5 weeks). The majority (60%) were gestational ages over 7 weeks. There were 26/45 cases with fetal heart activity (57,8%). There were 39/45 cases of placenta tending to develop towards the anterior surface of the uterus (86,7%). The image of the pregnancy mass with increased vascularity accounted for 93,3%, the pregnancy mass closely related to the uterine vascular bundles on both sides accounted for 53,3%. The average thickness of the remaining myometrium at the cesarean section scar site was 1,996±1,48 mm (Min: 0,3mm, Max: 6mm). The number of cases with the remaining myometrium thickness ≤ 2mm was 30/45 cases (66,7%). The average pre-treatment βhCG concentration was 78781,5±56885,6 IU/l (Max: 220508 IU/l, Min: 47,14 IU/l). There were 19/45 cases with pre-treatment βhCG concentration > 100000 IU/l (42,2%). Conclusion: The majority of patients had 2 or more cesarean sections and had a history of curettage/vaccination. The most common clinical symptoms were delayed menstruation combined with abnormal vaginal bleeding. Most cases had fetal cardiac activity. Paraclinical characteristics such as: tendency for the placenta to develop to the anterior surface of the uterus, increased vascularity of the fetus, close relationship of the uterine vascular bundles on both sides, and thin remaining myometrial layer thickness at the surgical scar site were all present in the majority of cases in the study. Pre-treatment βhCG concentration > 100000 IU/l was present in the majority. Transvaginal ultrasound and quantitative testing of βhCG concentration before treatment are valuable in definitive diagnosis and prognosis.