[Analysis of 96 cases with cesarean scar pregnancy]

To investigate the clinical manifestation, diagnosis, therapies and medical economics of cesarean scar pregnancy (CSP).

From Jan. 2005 to Dec. 2008, 96 patients with CSP treated in Obstetrics and Gynecology Hospital of Fudan University were studied retrospectively. Those cases were divided into 3 groups. Thirty-three patients were treated with methotrexate (MTX) 50 mg/m(2) intravenously guttae in group A. Among that 18 cases were treated with MTX, after 5-10 days they underwent dilation and curettage of uterus; 15 cases were given by dilation and curettage first if the level of serum human chorionic gonadotrophin-β (β-hCG) descent less than 30% in every 48 hours for 3 times after curettage, then MTX (50 mg/m(2)) intravenously guttae. Sixty patients were treated with MTX 100 mg bilateral uterine artery injection and embolization in group B. After 2 days, they underwent curettage. Group C: 3 patients were treated with laparotomy lesion excision. The following clinical parameters were compared, including blood loss (M), lesion diameter (x(-) ± s), blood β-hCG level (M) before treatment, the number of cases with myometrial thickness anterior to the CSP ≤ 3 mm, the resistant index (RI) ≤ 0.5, expense (x(-) ± s), hospital days (x(-) ± s) in those 3 groups. The correlation of blood loss with lesion diameter and blood β-hCG level was studied.

(1) Clinical manifestation: bleeding loss were 20 ml in MTX + curettage of group A, 10 ml in curettage + MTX of group A, 12 ml in group B and 200 ml in group C. The volume of bleeding loss in group C was significantly higher than those in group A or group B (P < 0.01). The lesion diameter were (23 ± 15) mm in curettage + MTX of group A and (30 ± 14) mm of group B, which were higher than (16 ± 8) mm of MTX + curettage of group A (P < 0.01). The lesion diameter of (52 ± 7) mm in group C were significantly bigger than those in the other groups (P < 0.01). The level of blood β-hCG levels were 21 592 U/L in MTX + curettage of group A, 979 U/L in curettage + MTX of group A, which reach statistical difference (P < 0.05). The level of blood β-hCG levels were 11 312 U/L in group B and 101 U/L in group C. Among 28 cases with RI ≤ 0.5, there was 8 cases in group A (24%, 8/33), 18 cases in group B (30%, 18/60) and 2 cases in group C (2/3). Among 23 cases with myometrial thickness anterior to the CSP ≤ 3 mm, there was 21 cases in group B (35%, 21/60), which were significantly higher than 2 in group A (6%, 2/33) and none in group C (P < 0.05). The expense were (5578 ± 3679) yuan in MTX + curettage of group A and (5346 ± 2765) yuan in curettage + MTX of group, which did not reach statistical difference (P > 0.05). The expense were (7860 ± 2104) yuan in group B, which were significantly higher than those in group A and (5004 ± 421) yuan in group C (P < 0.05). The hospital days were (15 ± 8) days and (19 ± 14) days of group A, (16 ± 10) days in group B and (17 ± 8) days in group C, there was no significant difference among those treatments (P > 0.05). (2) Correlation: there was positive correlation between bleeding loss and lesion diameter (r = 0.31, P < 0.05) or blood β-hCG level (r = 0.35, P < 0.05).

MTX intravenously guttae, MTX uterine artery injection and embolization, and laparotomy lesion excision were all properly used in treatment of CSP. MTX uterine artery injection and embolization was recommended for those with big lesion, high β-hCG level, less myometrial thickness anterior to the CSP or plentiful blood supply of the lesion but the expense might be high.