Joint evaluation method and system for cesarean scar pregnancy

Abstract

The invention relates to the technical field of medical treatment of cesarean section scar pregnancy evaluation and treatment, in particular to a combined evaluation method and system for cesarean section scar pregnancy. According to the method, serum beta-hCG examination, ultrasonic examination and nuclear magnetic examination are completed within 24 hours before an operation, the blood flow type around a gestational sac is measured through ultrasonic, and the blood flow type around the gestational sac is measured; the size of a gestational sac, the size of a gestational sac in a diverticulum and the thickness of a cesarean delivery scar are measured on the T2 weighted sagittal view image through nuclear magnetism, a comprehensive score is preset according to 0-2 scores by combining a serum beta-hCG result (the total score is 10), and surgical treatment is guided according to the score; according to the method, evaluation is accurate and sufficient, operation is easy, convenient and rapid, damage is small, predicted AUC values for operation failure, serious bleeding and continuous existence of lesions are 0.922, 0.955 and 0.862 respectively, applicability and traceability are high, and clinical treatment risks can be effectively guided to be reduced.

Description

TECHNICAL FIELD

[0001] The present application relates to the medical technical field of cesarean scar pregnancy evaluation and treatment, in particular to a combined evaluation method and system for cesarean scar pregnancy. BACKGROUND

[0002] Cesarean scar pregnancy refers to the implantation of the gestational sac in the cesarean scar. With the increase of cesarean section rate and the progress of diagnostic technology, the incidence of this disease is increasing year by year 1-2 , and can cause serious complications such as severe bleeding, uterine rupture, infertility and maternal death 3-4 , so effective treatment of this disease is very important.

[0003] At present, there are obvious deficiencies in the prediction model of surgical treatment effect of cesarean scar pregnancy, especially in the prediction of intraoperative bleeding and postoperative lesion persistence. The existing classification of cesarean scar pregnancy is mainly based on the construction of indicators such as cesarean scar thickness, gestational sac growth direction, gestational sac size and blood flow around the gestational sac. Among them, the American College of Obstetricians and Gynecologists guidelines divide it into "above the scar" and "in the diverticulum" according to the position relationship between the cesarean scar and the gestational sac 5 , and the existing scoring system in China divides it into five subtypes (I, IIa, IIb, IIIa and IIIb) according to the size of the gestational sac measured by ultrasound and the thickness of the cesarean scar 6 , and according to the existing scoring system, the risk of surgical treatment failure of cesarean scar pregnancy can be as high as 25.6% 7 .

[0004] In the diagnosis and treatment of cesarean scar pregnancy, ultrasound and magnetic resonance each have advantages and limitations: ultrasound has been regarded as the preferred diagnostic method for this disease for a long time because of its simple operation, non-invasiveness, low cost and no radiation 7 , and it has more advantages than magnetic resonance in displaying yolk sac, fetal heartbeat and blood flow 8 , but the diagnostic effect of ultrasound is highly dependent on the experience of the operator, and is greatly affected by the experience and interpretation report level of the clinician, and the soft tissue contrast of ultrasound is poorer than that of magnetic resonance, so it is difficult to realize the reproducible evaluation of the results 9 ; magnetic resonance can clearly show the relative position relationship between the cesarean scar and the gestational sac, accurately measure the thickness of the scar, and clearly show the degree of gestational sac protruding to the scar 9 , but its sensitivity in detecting fetal heartbeat and subtle blood flow is limited 8 .

[0005] The existing technology has significant defects in the evaluation and treatment prediction of cesarean scar pregnancy:

[0006] Firstly, the prediction model of the effect of relevant surgical treatment is not perfect, especially in the prediction of two key risk points of intraoperative bleeding and postoperative lesion persistence, which cannot provide accurate risk prediction basis for clinical treatment.

[0007] Secondly, the existing classification and scoring system index coverage is not comprehensive, only part of the index such as cesarean scar thickness and gestational sac size is constructed, the respective advantages of serum beta-hCG, ultrasound and nuclear magnetic examination are not fully integrated, which leads to the lack of comprehensiveness and sufficiency of the evaluation of the severity of the disease, and further makes the risk of surgical treatment failure according to these system evaluation as high as 25.6%.

[0008] Finally, the inherent limitations of single diagnostic method further affect the accuracy and reliability of the evaluation, the effect of ultrasound diagnosis is highly dependent on the experience of the operator, the contrast of soft tissue is poor and the result is low in repeatability, the sensitivity of nuclear magnetic in detecting fetal heartbeat and subtle blood flow is limited, neither of them can fully obtain the key information required for evaluation, and it is difficult to meet the demand of clinical precise evaluation of the disease, therefore, in view of the above status, it is urgent to develop a combined evaluation method and system for cesarean scar pregnancy to overcome the shortcomings in the current practical application. SUMMARY

[0009] The purpose of the present application is to provide a combined evaluation method and system for cesarean scar pregnancy to solve the problems raised in the above background art.

[0010] To achieve the above purpose, the present application provides the following technical scheme:

[0011] A combined evaluation method for cesarean scar pregnancy, comprising the following steps:

[0012] Performing serum beta-hCG examination, ultrasound examination and nuclear magnetic examination on the patients with cesarean scar pregnancy within a preoperative predetermined time;

[0013] Obtaining a plurality of imaging evaluation indexes through the ultrasound examination and nuclear magnetic examination, and obtaining serum beta-hCG level through the serum beta-hCG examination;

[0014] Comprehensive scoring according to the imaging evaluation indexes and serum beta-hCG level;

[0015] Guiding the surgical treatment scheme for cesarean scar pregnancy based on the comprehensive scoring results.

[0016] As a further scheme of the present application: the predetermined time is within 24 hours before operation.

[0017] As a further scheme of the present application: the imaging evaluation indexes include gestational sac surrounding blood flow related indexes, gestational sac size, gestational sac related indexes in diverticulum and cesarean scar thickness.

[0018] As a further scheme of the present application: the blood flow related index around the gestational sac is obtained by analyzing the ultrasound image, including three types of no blood flow, little blood flow and rich blood flow;

[0019] The gestational sac size, the gestational sac related index in diverticulum and the cesarean section scar thickness are obtained by measuring the T2 weighted sagittal image of nuclear magnetic resonance.

[0020] As a further scheme of the present application: the score level of the comprehensive score includes 0, 1 and 2, the total score of the comprehensive score is not more than 10, and the score is based on the serum β-hCG level, the blood flow related index around the gestational sac, the gestational sac size, the gestational sac related index in diverticulum and the cesarean section scar thickness.

[0021] As a further scheme of the present application: when the comprehensive score is more than 3.5, it is suggested that the risk of postoperative lesion persistence is increased, and it is suggested to strengthen the monitoring of serum β-hCG level and ultrasound examination after operation, and supplement drug treatment if necessary;

[0022] When the comprehensive score is more than 5.5, it is suggested that the risk of severe bleeding during operation is increased, and it is suggested to perform vascular embolization pretreatment before operation or to take uterine artery ligation hemostasis treatment during operation.

[0023] A system for realizing the combined evaluation method of cesarean section scar pregnancy, comprising an image acquisition unit, an image processing unit, a serum β-hCG measurement unit and a data application unit;

[0024] The image acquisition unit is used to acquire ultrasound images and nuclear magnetic images of patients with cesarean section scar pregnancy;

[0025] The image processing unit is signal connected with the image acquisition unit, and is used to process the ultrasound images and nuclear magnetic images and extract the imaging evaluation index;

[0026] The serum β-hCG measurement unit is used to quantitatively measure the serum β-hCG level of the patient before operation;

[0027] The data application unit is signal connected with the image processing unit and the serum β-hCG measurement unit respectively, and is used to receive the imaging evaluation index and the serum β-hCG level, perform comprehensive scoring and output surgical treatment scheme guidance information.

[0028] As a further scheme of the present application: the image acquisition unit includes an ultrasound device and a nuclear magnetic resonance device, and the basic clinical information of the patient is recorded synchronously when the images are acquired.

[0029] As a further scheme of the present application, the image processing unit is specifically used for identifying the blood flow type around the gestational sac in the ultrasound image, and measuring the average diameter of the gestational sac, the vertical distance from the diverticulum base to the top of the gestational sac in the diverticulum, and the myometrial thickness at the cesarean section scar in the magnetic resonance image.

[0030] As a further scheme of the present application, the data application unit is built-in with preset scoring standards, which can match corresponding scoring grades according to the received imaging evaluation indicators and serum β-hCG level, calculate a comprehensive score, and generate a targeted surgical treatment guidance suggestion.

[0031] Compared with the prior art, the present application has the following beneficial effects:

[0032] The evaluation is more accurate and sufficient. The serum β-hCG indicates the viability of the gestational sac, the ultrasound measurement of the blood flow signal around the gestational sac reflects the risk of intraoperative bleeding, the magnetic resonance accurately measures the size of the gestational sac, the magnetic resonance measurement of the size of the gestational sac in the diverticulum reflects the degree of erosion of the gestational sac to the cesarean section scar, and the magnetic resonance measurement of the thickness of the cesarean section scar reflects the tolerance of the cesarean section scar to the erosion and surgical damage of the gestational sac, so that multiple indicators are cooperated to realize comprehensive evaluation.

[0033] The implementation process is simple. The serum β-hCG, ultrasound and magnetic resonance examinations can be completed within 24 hours before surgery (only half a day), which is convenient and efficient.

[0035] The implementation has small damage. The ultrasound and magnetic resonance examinations are completely non-invasive, and the serum β-hCG examination only needs to be performed by venous blood sampling, which has small damage to the patient.

[0036] The scoring is fast and time-consuming. The scoring grades of the included indicators are set as 0, 1 and 2, and the total score is 10. According to the corresponding examination results before the operation, the scoring of the patient can be completed in a very short time.

[0037] The evaluation is efficient. ROC analysis shows that the system has high prediction ability for surgical treatment of cesarean section scar pregnancy. The AUC value for predicting surgical treatment failure is 0.922 (95% CI: 0.881-0.963, cutoff value 3.5), the AUC value for predicting severe bleeding is 0.955 (95% CI: 0.920-0.989, cutoff value 5.5), and the AUC value for predicting persistent lesions is 0.862 (95% CI: 0.782-0.941, cutoff value 3.5).

[0038] The system has strong applicability. At present, most medical institutions can perform serum β-hCG, ultrasound and magnetic resonance examinations, and have the basic conditions to implement the scoring system.

[0039] The system has strong traceability. The results of serum β-hCG, ultrasound and magnetic resonance examinations are important indicators for medical safety, which are objective and have strong traceability, and are rarely affected by subjective factors.

[0039] The clinical treatment can be targetedly guided, when the score of the patient is more than 3 points, it is indicated that the risk of postoperative lesion persistence is significantly increased, so as to facilitate the postoperative close monitoring of serum beta-hCG and ultrasound, and necessary drug treatment is supplemented as early as possible; when the score is more than 6 points, it is indicated that the risk of intraoperative severe bleeding is obviously increased, and preoperative uterine artery embolization pretreatment or intraoperative uterine artery ligation can be suggested, so as to effectively reduce the risk of intraoperative severe bleeding. BRIEF DESCRIPTION OF DRAWINGS

[0040] Figure 1 It is a schematic diagram of a cesarean scar pregnancy combined evaluation system in the embodiment of the application.

[0041] Figure 2 It is a flow chart of a cesarean scar pregnancy combined evaluation method in the embodiment of the application.

[0042] Figure 3 It is a schematic diagram of ultrasound measurement of blood flow signals around a gestational sac in the embodiment of the application.

[0043] Wherein, A is no blood flow; B is a little blood flow; C is rich blood flow; in addition, a is a gestational sac; b is a blood flow signal.

[0044] Figure 4 It is a schematic diagram of nuclear magnetic measurement of gestational sac related indexes and cesarean scar thickness in the embodiment of the application.

[0045] Wherein, a is a uterus; b is the size of a gestational sac in a diverticulum; c is a bladder.

[0046] Figure 5 It is a flow chart of experimental population screening of a cesarean scar pregnancy combined evaluation system in the embodiment of the application.

[0047] Figure 6 It is a ROC curve diagram of different curative effect evaluation of a cesarean scar pregnancy combined evaluation system in the embodiment of the application. DETAILED DESCRIPTION

[0048] The technical solutions in the embodiments of the application will be described clearly and completely in combination with the drawings in the embodiments of the application. Obviously, the described embodiments are only part of the embodiments of the application, rather than all the embodiments of the application. Based on the embodiments in the application, all other embodiments obtained by those skilled in the art without creative labor fall within the protection scope of the application.

[0049] As Figures 1-6 shown, the specific implementation of the application is described in detail in combination with specific embodiments.

[0050] 1. Composition of a cesarean scar pregnancy combined evaluation system

[0051] As Figure 1 shown, the cesarean scar pregnancy combined evaluation system provided by the application comprises an image acquisition unit S101, an image processing unit S102, a serum β-hCG measurement unit S103 and a data application unit S104, and each unit cooperates to realize comprehensive combined evaluation of the cesarean scar pregnancy.

[0052] The image acquisition unit S101 is used to acquire the relevant images of the cesarean scar pregnancy patient, and specifically uses an ultrasonic device and a magnetic resonance (MRI) device to continuously acquire images. During the acquisition process, the patient's name, age, hospital number and other basic clinical information need to be recorded synchronously. At the same time, this unit needs to comprehensively consider the patient's cooperation degree, the resolution and interference of the image acquisition machine and other influencing factors to ensure that the acquired images are clear and the relevant marks are not missed, and to provide a reliable image basis for subsequent index measurement. This design makes the image acquisition more targeted and reliable, and guarantees the accuracy of subsequent evaluation.

[0053] The image processing unit S102 is signal connected with the image acquisition unit S101, and is used to process and detect the acquired ultrasonic images and magnetic resonance images, and measure relevant evaluation indexes. Specifically, it can realize the identification of the blood flow type around the gestational sac in the ultrasonic image, and the accurate measurement of the size of the gestational sac, the size of the gestational sac in the diverticulum and the thickness of the cesarean scar in the magnetic resonance image, solving the problem that single image diagnosis cannot comprehensively obtain key indexes, and providing data support for multi-dimensional evaluation.

[0054] The serum β-hCG measurement unit S103 is used to quantitatively measure the serum β-hCG level of the cesarean scar pregnancy patient before operation. This index can directly indicate the vitality of the gestational sac and is one of the key indexes for evaluating the pregnancy state. The measurement result is objective and traceable, reducing the influence of subjective factors on evaluation.

[0055] The data application unit S104 is signal connected with the image processing unit S102 and the serum β-hCG measurement unit S103 respectively, and is used to receive and process the measurement data transmitted by the above units, to provide data support for subsequent risk scoring and treatment scheme guidance, to ensure efficient and accurate data processing, and to provide timely basis for clinical decision-making.

[0056] 2. A cesarean scar pregnancy combined evaluation method

[0057] As Figure 2 shown, the cesarean scar pregnancy combined evaluation method of the application specifically comprises the following steps:

[0058] 2.1 Image acquisition S201

[0059] For patients with cesarean scar pregnancy, image data is continuously collected within 24 hours before surgery using ultrasound equipment and magnetic resonance equipment. During the collection process, the patient's name, age, and hospital number are recorded. At the same time, the patient's cooperation, the resolution of the image collection machine, and the interference are considered to ensure that the collected ultrasound and magnetic images are clear, and the relevant anatomical structures and identifiers are not missing. This step is simple to operate, the required examination can be carried out in most medical institutions, has strong applicability, and can be completed in a short time, improving the evaluation efficiency.

[0060] 2.2 Image data analysis S202

[0061] The collected ultrasound and magnetic images are transmitted to the image processing unit, which processes and analyzes the images to obtain various indicators required for evaluation:

[0062] Ultrasound image analysis: The blood flow around the gestational sac is measured by ultrasound image, and the specific classification criteria are as follows:

[0063] (1) No blood flow: less than 2 point-like blood flow signals are detected around or inside the lesion;

[0064] (2) Little blood flow: 3-4 point-like or short linear blood flow signals are visible around or inside the lesion;

[0065] (3) Abundant blood flow: there are more than 4 short linear or dendritic blood flow signals around or inside the lesion.

[0066] This classification result can directly reflect the risk of intraoperative bleeding, providing a key basis for surgical risk prediction.

[0067] Magnetic image analysis: The indicators are measured on the T2-weighted sagittal image, where the gestational sac size is the average diameter of the gestational sac (unit: mm), the cesarean scar thickness is the myometrial thickness at the cesarean scar (unit: mm), and the intracerivical gestational sac size is the vertical distance from the base of the diverticulum to the top of the intracerivical gestational sac (unit: mm). Magnetic resonance examination can accurately measure the above indicators, clearly show the relative position relationship between the cesarean scar and the gestational sac, and determine the erosion degree of the gestational sac to the cesarean scar and the tolerance degree of the scar to surgical damage, making up for the shortcomings of ultrasound in soft tissue contrast and repeatability.

[0068] 2.3 Serum β-hCG measurement S203

[0069] The serum β-hCG level (mIU / mL) of patients with cesarean scar pregnancy was quantitatively measured using a serum β-hCG measurement unit. This test only requires venous blood collection, which is minimally invasive to the patient. The measurement results are highly objective and traceable, and are rarely affected by subjective factors. The value can effectively indicate the viability of the gestational sac and provide an important reference for assessing the severity of pregnancy.

[0070] 2.4 Risk Score S204

[0071] To identify risk factors affecting the surgical treatment outcome of cesarean scar pregnancy, this application statistically analyzed the clinical data of 191 patients who underwent surgical treatment for cesarean scar pregnancy, comparing the clinical characteristics of the successful and unsuccessful treatment groups. The results are shown in Table 1 below:

[0072] Table 1. Comparison of clinical characteristics between the successful and unsuccessful surgical treatment groups for cesarean scar pregnancy in 1191 cases.

[0073]

[0074]

[0075]

[0076] Table 1 shows that serum β-hCG level, gestational sac size, gestational sac size within the diverticulum, cesarean section scar thickness, and blood flow pattern around the gestational sac are key risk factors affecting the outcome of surgical treatment (p<0.05 or p<0.001). Further analysis of these continuous variables using ROC curves and calculation of their cutoff values ​​are shown in Table 2 below.

[0077] Table 2. ROC output results of serum β-hCG, gestational sac, and gestational sac within the diverticulum.

[0078]

[0079] Based on the above clinical characteristic comparison results, the cutoff value obtained from ROC analysis, and combined with existing cesarean scar pregnancy scoring systems and literature evidence, risk scores were calculated based on serum β-hCG levels, ultrasound measurement of blood flow patterns around the gestational sac, MRI measurement of gestational sac size, size of the gestational sac within the diverticulum, and cesarean scar thickness. The scoring levels were set as 0, 1, and 2 points, and the specific scoring criteria are shown in Table 3 below:

[0080] Table 3 Scores for different indicators in patients with cesarean scar pregnancy

[0081]

[0082] The scoring criteria are based on existing cesarean scar pregnancy scoring systems, literature evidence, and the cutoff values ​​measured in this application. The scoring rules are simple and clear, and the operation is convenient. Patient scoring can be completed in a very short time, which effectively improves the efficiency of clinical application.

[0083] Calculate the sum of 2.5 scores for S205

[0084] The scores of the above indicators are summed to obtain the patient's comprehensive score, which has a total score of 10 points. The single total score can intuitively reflect the severity of the patient's condition and the level of surgical risk, making it easier for clinicians to quickly grasp the core information.

[0085] 2.6 Surgical Treatment Guidelines S206

[0086] Based on the patient's comprehensive score and the cutoff values ​​for each risk prediction, the clinical surgical treatment plan is formulated to guide the following:

[0087] When the patient's comprehensive score is ≤3.5, it indicates a low risk of surgical treatment failure and persistent lesions after surgery; when the score exceeds 3.5, the risk of persistent lesions after surgery increases significantly. It is recommended to closely monitor serum β-hCG levels and ultrasound examination results after surgery, and supplement with drug therapy as early as possible if necessary to reduce the risk of residual lesions.

[0088] When the patient's overall score is ≤5.5, the risk of severe intraoperative bleeding is low; when the score exceeds 5.5, the risk of severe intraoperative bleeding increases significantly. It is recommended to perform uterine artery embolization pretreatment or uterine artery ligation during the operation to effectively reduce the risk of severe intraoperative bleeding and ensure surgical safety.

[0089] This step enables precise alignment between assessment results and clinical treatment, resolving the problem of insufficient prediction of intraoperative bleeding and postoperative lesion persistence in existing scoring systems, and can significantly improve treatment outcomes.

[0090] 2.7 Evaluation of Treatment Efficacy S207

[0091] By meticulously recording key data such as intraoperative blood loss and operation duration, and conducting regular postoperative follow-ups, the system monitors the decline in serum β-hCG levels and the regression of lesions via ultrasound examination. This comprehensive assessment evaluates the clinical efficacy of the system in guiding surgical treatment of cesarean scar pregnancy. Specific observation points include the overall surgical failure rate, the rate of severe intraoperative bleeding, and the rate of persistent postoperative lesions, providing clinical evidence for the optimization and promotion of the system.

[0092] 3. Experimental verification and effect analysis

[0093] To verify the effectiveness of the combined evaluation method and system of this invention, this application screened 224 patients undergoing cesarean scar pregnancy surgery. Among them, 33 patients were excluded for the following reasons: 2 cases of twin pregnancy, 11 cases of severe systemic diseases, 2 cases of severe coagulation dysfunction, 2 cases of surgical treatment and examination time exceeding 1 week, 5 cases of gestational age exceeding 12 weeks, 5 cases of incomplete clinical data, and 6 cases of preoperative uterine artery embolization. Finally, 191 patients were included in the study, of which 154 cases were successfully treated and 37 cases failed (including 24 cases of severe intraoperative bleeding and 13 cases of persistent lesions).

[0094] A comprehensive assessment of 191 patients was conducted using the combined assessment system of this invention. The differences in comprehensive scores among different groups of patients were analyzed by t-test, and the results are shown in Table 4 below:

[0095] Table 4 Comparison of the new system scores among different groups of patients

[0096]

[0097] The results showed that the comprehensive scores of the treatment failure group, the severe bleeding group, and the persistent lesion group were significantly higher than those of the corresponding successful group, indicating that the comprehensive score of this system can effectively distinguish patients with different treatment outcomes.

[0098] Further analysis of the system's predictive performance using ROC curves yielded the results shown in Table 5 below:

[0099] Table 5. ROC output results of patients in different groups

[0100]

[0101] The above results suggest that the combined assessment system of the present invention has a high predictive ability and can provide accurate and reliable decision support for clinical treatment.

[0102] Therefore, according to the table above, the comprehensive score of the treatment failure group was 6.58±1.21 points, which was significantly higher than that of the successful treatment group (2.77±1.56 points) (t=-11.420, p<0.001); the comprehensive score of the severe bleeding group was 6.63±1.38 points, which was significantly higher than that of the non-severe bleeding group (2.69±1.57 points) (t=-11.589, p<0.001); and the comprehensive score of the lesion persistence group was 5.15±1.57 points, which was significantly higher than that of the lesion regression group (2.69±1.57 points) (t=-5.425, p<0.001). This indicates that the comprehensive score of this system can effectively distinguish patients with different treatment outcomes.

[0103] Further analysis of the predictive efficacy of the system using ROC curves showed that the system had an AUC value of 0.922 (95% CI: 0.881-0.963, cutoff value 3.5) for predicting surgical treatment failure, 0.955 (95% CI: 0.920-0.989, cutoff value 5.5) for predicting severe bleeding, and 0.862 (95% CI: 0.782-0.941, cutoff value 3.5) for predicting lesion persistence. This indicates that the combined assessment system of the present invention has a high predictive ability and can provide accurate and reliable decision support for clinical treatment.

[0104] In summary, the combined assessment method and system for cesarean scar pregnancy of the present invention, by integrating the advantages of serum β-hCG, ultrasound and MRI examinations, achieves a comprehensive and accurate assessment of the severity of cesarean scar pregnancy. The implementation process is simple, minimally invasive, rapid in scoring, highly applicable and traceable. It can effectively reduce the risk of surgical treatment failure, severe intraoperative bleeding and persistent postoperative lesions, and has important clinical application value.

[0105] The references are as follows:

[0106] 1. Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson CJ. First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment Cesarean section scar. Ultrasound Obstet Gynecol. 2003; 213:220-7.

[0107] 2. Seow KM, Huang LW, Lin YH, Lin MY, Tsai YL, Hwang JL. Cesarean scarpregnancy: issues in management. Ultrasound Obstet Gynecol. 2004; 233:247-53.

[0108] 3.Timor-Tritsch IE,Monteagudo A,Goldstein SR.Early first-trimestertransvaginal ultrasound screening for Cesarean scar pregnancy in patientswith previous Cesarean delivery:analysis of the evidence.Am J ObstetGynecol.2024.

[0109] 4.Yang J,Luo X,Guo L,Cheng H,Tang Y,Song Y et al.A novel scoringmodel to predict massive hemorrhage during dilatation and curettage followingfocused ultrasound ablation surgery in patients with type 2cesarean scarpregnancy.Int J Hyperthermia.2025;421:2495362.

[0110] 5.Miller R,Timor-Tritsch IE,Gyamfi-Bannerman C.Society for Maternal-Fetal Medicine(SMFM)Consult Series#49:Cesarean scar pregnancy.Am J ObstetGynecol.2020;2225:B2-b14.

[0111] 6.Ban Y,Shen J,Wang X,Zhang T,Lu X,Qu W et al.Cesarean Scar EctopicPregnancy Clinical Classification System With Recommended SurgicalStrategy.Obstet Gynecol.2023;1415:927-36.

[0112] 7.Moro F,Bolomini G,Sibal M,Vijayaraghavan SB,Venkatesh P,Nardelli Fet al.Imagingin gynecologicaldisease(20):clinicaland ultrasoundcharacteristics of adnexal torsion.Ultrasound Obstet Gynecol.2020;566:934-43.

[0113] 8. Wang K, Jing F. Comparison of Diagnostic Efficacy among TransvaginalSonography, Transabdominal Sonography, and 3.0T Magnetic Resonance Imaging in Early Cesarean Scar Pregnancy. J Healthc Eng. 2022; 2022:9714369.

[0114] 9.Xiao

[0115] It should be noted that, in this invention, although the specification describes the embodiments, not every embodiment contains only one independent technical solution. This way of describing the specification is only for clarity. Those skilled in the art should regard the specification as a whole. The technical solutions in each embodiment can also be appropriately combined to form other embodiments that can be understood by those skilled in the art.

Claims

1. A combined assessment method for cesarean scar pregnancy, characterized in that, Includes the following steps: Serum β-hCG, ultrasound and MRI were performed on patients with cesarean scar pregnancy within the pre-planned time frame before surgery. Multiple imaging assessment indicators are obtained through the ultrasound and MRI examinations, and serum β-hCG levels are obtained through the serum β-hCG examination. A comprehensive score was calculated based on the aforementioned imaging assessment indicators and serum β-hCG levels; The surgical treatment plan for cesarean scar pregnancy is guided by the comprehensive scoring results.

2. The combined assessment method for cesarean scar pregnancy according to claim 1, characterized in that, The preset time is within 24 hours before the operation.

3. The combined assessment method for cesarean scar pregnancy according to claim 1, characterized in that, The imaging assessment indicators include blood flow-related indicators around the gestational sac, gestational sac size, gestational sac-related indicators within the diverticulum, and cesarean section scar thickness.

4. The combined assessment method for cesarean scar pregnancy according to claim 3, characterized in that, The blood flow-related indicators around the gestational sac were obtained through ultrasound image analysis, including three subtypes: no blood flow, little blood flow, and abundant blood flow. The size of the gestational sac, related indicators of the gestational sac within the diverticulum, and the thickness of the cesarean section scar were obtained by measuring T2-weighted sagittal MRI images.

5. The combined assessment method for cesarean scar pregnancy according to claim 1, characterized in that, The comprehensive score is rated on a scale of 0, 1, and 2, with a total score not exceeding 10 points. The scoring criteria include serum β-hCG level, blood flow-related indicators around the gestational sac, gestational sac size, gestational sac-related indicators within the diverticulum, and cesarean section scar thickness.

6. The combined assessment method for cesarean scar pregnancy according to claim 5, characterized in that, When the overall score exceeds 3.5, it indicates an increased risk of persistent lesions after surgery. It is recommended to strengthen the monitoring of serum β-hCG levels and ultrasound examinations after surgery, and supplement with drug treatment if necessary. When the overall score exceeds 5.5, it indicates an increased risk of severe intraoperative bleeding, and it is recommended to perform preoperative vascular embolization or intraoperative uterine artery ligation for hemostasis.

7. A system for implementing the combined assessment method for cesarean scar pregnancy as described in claim 1, characterized in that, It includes an image acquisition unit, an image processing unit, a serum β-hCG measurement unit, and a data application unit; The image acquisition unit is used to acquire ultrasound and MRI images of patients with cesarean section scar pregnancy. The image processing unit is signal-connected to the image acquisition unit and is used to process the ultrasound image and MRI image and extract imaging evaluation indicators. The serum β-hCG measurement unit is used to quantitatively measure the patient's preoperative serum β-hCG level; The data application unit is connected to the image processing unit and the serum β-hCG measurement unit respectively, and is used to receive the imaging assessment indicators and serum β-hCG levels, perform comprehensive scoring, and output surgical treatment plan guidance information.

8. The combined assessment system for cesarean scar pregnancy according to claim 7, characterized in that, The image acquisition unit includes ultrasound equipment and MRI equipment, and records the patient's basic clinical information simultaneously when acquiring images.

9. The combined assessment system for cesarean scar pregnancy according to claim 7, characterized in that, The image processing unit is specifically used to identify the blood flow pattern around the gestational sac in ultrasound images, and to measure the average diameter of the gestational sac, the vertical distance from the base of the diverticulum to the top of the gestational sac within the diverticulum, and the thickness of the myometrium at the cesarean section scar in MRI images.

10. The combined assessment system for cesarean scar pregnancy according to claim 7, characterized in that, The data application unit has a built-in preset scoring standard, which can match the corresponding scoring level according to the received imaging assessment indicators and serum β-hCG level, calculate the comprehensive score, and generate targeted surgical treatment guidance suggestions.

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