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剖宫产瘢痕妊娠(caesarean scar pregnancy,CSP)的子宫同正常妊娠一样增大,有时子宫下段隆起膨大。腹腔镜下可见剖宫产瘢痕处浆膜层凸起,宫腔镜下可见子宫下段糟脆蜕膜组织及绒毛组织。病理检查见前次剖宫瘢痕处的纤维肌组织间存在滋养细胞,胎盘组织周围没有底蜕膜及子宫肌肉组织,仅可见一些结缔组织。妊娠7周的CSP患者全子宫切除标本:见胎囊种植在前次剖宫产切口处,胎囊和蜕膜疏松的附着在肌壁内。CSP多数在妊娠早期发生胚胎停育而发生阴道出血、局部积血、宫腔及宫颈管内积血,外生型CSP与早期妊娠子宫破裂有关。CSP继续妊娠至中晚期,易发生前置胎盘、胎盘植入、子宫破裂、分娩后胎盘不剥离或剥离面大出血等并发症。
The caesarean scar pregnancy (caesarean scar pregnancy, CSP) of the uterus increases with the normal pregnancy, and sometimes enlarged lower uterine segment bulge. Laparoscopic cesarean scar visible at the serosa layer bulging hysteroscopic lower uterine section of the decidual tissue and villous tissue. Pathological examination, see the last cesarean section at the presence of fibromuscular trophoblast cells, placenta tissue around the end of the decidua and uterine muscle tissue, only visible in some connective tissue. Hysterectomy specimens of CSP patients at 7 weeks of gestation: see fetal sac implantation in the previous cesarean section incision, fetal sac and decidua loose attachment in the muscle wall. Most CSP embryos in the early gestation occurred during vaginal bleeding, hemorrhage, intrauterine and cervical canal hemorrhage, exogenous CSP and early pregnancy related uterine rupture. CSP to the late pregnancy to the late, prone to placenta previa, placenta accreta, uterine rupture, placenta accreta do not peel or bleeding after bleeding and other complications.