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ORIGINAL ARTICLE
Year : 2018  |  Volume : 2  |  Issue : 2  |  Page : 88-94

Comparison of Five Treatment Strategies for Cesarean Scar Pregnancy


Department of Gynaecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200032, China

Correspondence Address:
Xiao-Hong Xue
No. 419 Fangxie Road, Huangpu District, Shanghai 200032
China
Xin Lu
No. 419 Fangxie Road, Huangpu District, Shanghai 200032
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2096-2924.242751

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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.


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