Analysis of the Effect of Mifepristone and Misoprostol Pretreatment Combined with Hysteroscopy on Type Ⅱ Cesarean Scar Pregnancy

OBJECTIVE To explore the therapeutic effect of pretreatment with mifepristone and misoprostol combined with hysteroscopic clearance of pregnant material in type II cesarean scar pregnancy(CSP). METHODS The clinical data of CSP patients from January 2017-December 2018 in Wuxi Maternal and Child Health Hospital were analyzed retrospectively. According to the CSP classification standard formulated by the branch of Obstetrics and Gynecology of Chinese Medical Association in 2016, 118 patients with CSP of type I and type II were divided into 2 groups:type I(61 cases) and type II(57 cases). To collect the general data of patients and the relevant indexes of surgical treatment(including operation time, intraoperative bleeding volume, hospitalization days, conversion rate, single operation success rate, total cure rate), evaluate the treatment effect, and compare the treatment effect of the two groups. RESULTS There was no significant difference between the two groups in general data, operation time, blood loss and hospitalization days. The conversion rate of type I and type II CSP to abdominal surgery was 4.9% and 5.3%, respectively. The success rate of single hysteroscopic surgery was 91.8% and 89.5%, respectively. There was no case of second operation or hysterectomy, and the total cure rate was 100%. There was no statistical difference between the two groups. Compared with type Ⅰ, the cases of intraoperative balloon compression hemostasis in type Ⅱ increased, there was a significant difference between the two groups(P<0.05). CONCLUSION Mifepristone and misoprostol combined with hysteroscopic clearance of pregnancy can be equally safe and effective in the treatment of type II CSP patients, but peri operative preparations should be made to deal with the massive hemorrhage in the scar site and transfer to the abdomen for the removal of pregnancy focus and the repair of uterine scar.