Comparison of three treatment strategies for cesarean scar pregnancy

• DOI: 10.1007/s00404-017-4426-5
• Publication Date: 2017-06-19T23:26:12Z
• Authors: Guangquan Liu; Jiacong Wu; Jian Cao; Yunping Xue; Chencheng Dai; Juan Xu; Xuemei Jia
• Keywords: Adult; Databases, Factual; Cesarean Section; Uterus; Blood Loss, Surgical; Abortion, Induced; Dilatation and Curettage; Pregnancy, Ectopic; 3. Good health; Cicatrix; 03 medical and health sciences; Methotrexate; 0302 clinical medicine; Pregnancy; Humans; Female; Retrospective Studies

To explore the optimal treatment for cesarean scar pregnancy.In total, 86 women diagnosed with a cesarean scar pregnancy were divided into three groups according to treatment. The human chorionic gonadotrophin (hCG) decline percentage, intraoperative blood loss and success rate were analyzed in Group A [combination of uterine arterial embolization (UAE), local methotrexate (MTX) injection and dilation & curettage (D&C)], Group B (combination of UAE and local MTX injection) and Group C (D&C). Then, the best treatment was carefully analyzed, and recommendations were provided.The success rate was highest in Group A (97.5%) compared with Group B (76%) and Group C (63.15%). The reduction in hCG was greatest in Group A (86.62%, 44.0-99.97%) compared with group B (67.83%, 18.0-98.03%) and Group C (68.21%, 27.0-93.24%). The intraoperative blood loss was lowest in Group A (44.881, 5-200 ml) compared with Group C (224.737, 10-1000 ml). Additionally, we found that the best time to perform D&C in group A depended on the hCG reduction percentage, and a 35% reduction after UAE and local MTX injection could be used as the indicator to perform D&C.The combination of UAE, local MTX injection and D&C for CSP patients is the optimal treatment strategy. A 35% reduction in hCG after UAE and local MTX injection can be recommended as the indicator to perform D&C.