At one time China’s cesarean section rate was as high as 60-70%, much higher than the 30% rate set by the WHO. Could it be that the Chinese have lost the ability to give birth naturally. When so many women cried and cried and did not want to try to give birth on their own or gave up trying halfway and tried to find a way to ask for a cesarean section, most of them thought that they could only give birth once in their lives, so why would they want to put themselves through something so unpredictable, and that everything would go well with a single incision, and some of them even invited a master to figure out a good time and day for the cesarean section to take place in the middle of the night. So more than ten years have passed, a large number of 30-40-year-old women on the stomach left a scar of beauty. But who would have thought that with the opening up of the second child, the once-in-a-lifetime delivery can be done twice, and when a large number of women with cosmetic scars on their appearance, with a scarred uterus are pregnant with two babies, problems ensue. Cesarean scar pregnancy – According to the general experience, if a pregnant woman wants to have this baby, she may not go to the hospital for a checkup until it’s time to build a file, which is often already 3 months old. And who knew that this child would be quietly planted into the uterine scar, and the term cesarean scar pregnancy was born. A baby that grows into the scar will hold it thin enough to wear out the uterus and cause it to rupture; it will grow into the uterine muscle and cause placenta implantation. All of these problems will ultimately lead to a high-risk pregnancy, leading to a geometrically increasing number of late-pregnancy aggressive placenta praevia placenta implantation occurrences, and obstetrics will become a blood hog, posing a serious threat to maternal life and well-being. And this situation can be avoided. The incidence of cesarean scar pregnancy is not as high as 1/2000, but then foreign statistics, and for such a high denominator of the cesarean population in our country, the rate must only be higher. So is there anything we doctors or expectant moms can do to prevent this from happening? The answer is: no. So how can we minimize the possible negative consequences of a cesarean scar pregnancy? Early diagnosis is crucial, and 5 weeks of pregnancy can clarify where the baby will land. If you have a history of cesarean section, make sure you remind your doctor to look at the gestational sac in relation to the scar, which can be done with a combination of transabdominal and transvaginal ultrasound to improve accuracy. However, where the gestational sac is located in the scar, you should not take the chance of carrying it to term as the chances of developing an aggressive placenta praevia at a later stage are very high. This means that women with a history of cesarean section should have an early ultrasound to clarify whether the pregnancy is a cesarean scar and terminate the pregnancy as soon as possible if found. The termination of a cesarean scar pregnancy is also different from a normal abortion, because the stopping of bleeding after an abortion relies on uterine muscle contraction, squeezing the uterine blood vessels and occluding them. The thinning of the muscle layer at the site of the C-section scar and the lack of pressure during contraction may result in hemorrhage during abortion. Therefore, if the diagnosis is a C-section scar pregnancy, the abortion must be performed in a hospital that has a blood source, hemostatic measures (e.g., uterine artery embolization), and experience in this field. Most of the tertiary hospitals and affiliated hospitals in Beijing are now equipped with the personnel and instruments to treat cesarean scar pregnancies. They also all have a wealth of clinical experience, and a variety of methods are basically successful in terminating pregnancy. What is being referred to here is the situation in early pregnancy and also before the placenta forms. More specifically, it is what we doctors and pregnant women need to do before the 10th week of pregnancy. The success rate of diagnosis and management is high during this period, and the risk of hemorrhage and uterine rupture is relatively low, which makes it a more ideal time. But if it is discovered beyond this period that the placenta is implanted on the cesarean scar, or even if there is placenta praevia placenta implantation, what should be the next step in the trade-off? I’ll move on to that next time.