探讨超声监测下剖宫产瘢痕部位妊娠声像图特点及其预后。

对2013年1月至2015年8月经广东省妇幼保健院产前超声诊断为剖宫产瘢痕妊娠的8例孕妇均从早孕期至分娩前定期超声检查，并经孕期磁共振成像（6例）或剖宫产后检查证实为胎盘植入。追溯8例孕妇早孕期经阴道超声图像特征，观察其早孕期妊娠囊和丛密绒毛膜位置、记录超声随访结果、剖宫产次数、最终诊断结果及妊娠转归并进行分析。

8例孕妇妊娠早期超声均诊断为瘢痕妊娠，超声诊断胎盘植入的孕周为11~24周。早孕期二维超声均显示丛密绒毛膜位置位于妊娠囊下缘，覆盖在剖宫产瘢痕上增殖的丛密绒毛回声高于平滑绒毛膜和包蜕膜，且增殖的丛密绒毛膜厚于周边平滑绒毛膜和包蜕膜。孕期超声随访中8例孕妇中原丛密绒毛膜所覆盖的位置与后期胎盘的位置大致相同，不随孕周增加而上移，呈现不同程度的前置胎盘状态，胎盘均覆盖于剖宫产瘢痕上。超声诊断剖宫产瘢痕部位妊娠伴胎盘植入后3例经双侧髂内动脉球囊封堵术后引产终止妊娠；5例有生育意愿的孕妇选择继续妊娠，经双侧髂内动脉球囊封堵术后4例剖宫产分娩活婴，l例分娩一活婴并子宫切除。

早孕期剖宫产瘢痕部位妊娠在中晚孕期可发展为胎盘植入，如在早孕期观察到丛密绒毛膜覆盖在子宫瘢痕上，可诊断瘢痕妊娠，对有强烈生育意愿选择继续妊娠的孕妇，应高度警惕妊娠中晚期前置胎盘伴胎盘植入，密切随诊观察。

To explore ultrasonographic characteristics and prognosis of cesarean scar pregnancy in the ultrasound.

To conducted a retrospective study of 8 cases of diagnoses of cesarean scar pregnancy in ultrasound in our hospital from January 2013 to August 2015. All cases had ultrasonographic examinations regularly during the pregnancy and were confirmed placenta increta by cesarean section or prenatal MRI (6 cases). The imaging characteristics of 8 cases of pregnant women in early pregnancy by transvaginal ultrasound, and the positions of gestational sac and chorion frondosum were observed. Ultrasonic follow-up results, numbers of cesarean delivery, final diagnosis, and pregnancy outcome were analyzed.

Eight cases of patients were diagnosed cesarean scar pregnancy, and all of ceses were diagnosed placenta increta by ultrasound from 11 weeks to 24 weeks of gestation. It was found that the positions of chorion frondosum were located in the lower edge of gestational sac in Two-dimensional ultrasound and the chorion frondosum was covered in cesarean section scar. The echoes of proliferous chorion frondosum were stronger than the rest of chorion leve and decidua reflexa, and the thickness of proliferous chorion frondosum were thicker than the rest of chorion leve and decidua reflexa. In the follow-up ultrasound of 8 cases in the second trimester, the original position of chorion frondosum which covered and the position of placenta were roughly similar. The position of placenta did not move up with the gestational weeks, in addition, appeared as placenta previa and covered in cesarean section scar. Five patients had strong childbearing willing of continue to conceive, one case of which needed hysterectomy, four of which underwent cesarean section delivery with alive births after using bilateral iliac arteries balloon occlusion. The rest 3 cases underwent induction of labor after using bilateral iliac arteries balloon cclusion.

Cesarean scar pregnancy in first pregnancy may be develop as placenta accreta in second and third trimester pregnancy. If chorion frondosum was observed to cover cesarean section scar by ultrasound in early pregnancy, scar pregnancy diagnosis was established. Pregnant women who have strong willing to continue their pregnancy should be pay more attentin to thiers placenta previa and placenta percreta in second and third trimester pregnancy. Close follow-up are needed.