Comparison of Five Treatment Strategies for Cesarean Scar Pregnancy

• Main Authors: Feng-Yi Xiao, Xiao-Hong Xue, Xin Lu
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2018-01-01
• Series: Reproductive and Developmental Medicine
• Subjects: Cesarean Scar Pregnancy; Hysteroscopy; Laparoscopy; Laparotomy; Uterine Artery Chemoembolization
• Online Access: http://www.repdevmed.org/article.asp?issn=2096-2924;year=2018;volume=2;issue=2;spage=88;epage=94;aulast=Xiao

Objective: To explore appropriate treatment strategy for cesarean scar pregnancy (CSP) in the first and second trimester. Methods: Clinical characteristics and treatment strategies in 182 patients with CSP were retrospectively analyzed. Treatment strategies were as follows: Group A (n = 102), uterine artery chemoembolization (UACE) followed by dilation and curettage (D&C); Group B (n = 63), D&C; Group C (n = 6), hysteroscopy; Group D (n = 6), laparotomy; and Group E (n = 5), laparoscopy. The basic clinical findings were collected and analyzed, along with the curative effects. Results: The preoperative serum beta-human chorionic gonadotropin (β-HCG) level was in the order of Group D, A>B, C>E (P = 0.001); the size of gestational sac (GS) was in the order of Group D, E>A, C>B (P = 0.000); and the thickness of the anterior myometrium was in the order of Group B>A, C>D, E (P = 0.000). Three cases in the second trimester were all in Group D; two cases were treated with UACE before laparotomy with moderate blood loss (100 and 200 mL, respectively) and the third case was initially treated with D&C and had severe hemorrhage. Conclusions: The diameter of GS, thickness of the anterior myometrium, and preoperative β-HCG level are important factors for the choice of treatment. UACE combined with D&C is a useful measure for most Type 2 CSP cases in the first trimester. For Type 2 CSP cases in the second trimester, UACE before laparotomy could be a reasonable choice.