[Cesarean scar pregnancy: an analysis of 100 cases]

To explore the clinical diagnosis and treatment of cesarean scar pregnancy (CSP).

The clinical data of 100 CSP patients during the period of January 2003 to March 2011 were collected for a retrospective analysis.

Among 100 cases of CSP, there were cases of asymptomatic (45%, n = 45), vaginal hemorrhage (55%, n = 55) and lower abdominal pain (7%, n = 7); among first diagnosed (n = 81), the cases were diagnosed (n = 75) or misdiagnosed (n = 6); among 19 hospital referrals, 18 were confirmed and 1 case was misdiagnosed as choriocarcinoma. Treatments included ultrasound monitoring curettage after UAE (uterine artery embolism) (n = 56), pure ultrasound monitoring curettage (n = 30), laparoscopic lumpectomy after UAE (n = 2), laparoscopic lumpectomy (n = 2), methotrexate only (n = 3), hysterectomy (n = 2), UAE hemostasis (n = 3) and Foley catheter balloon compression hemostasis (n = 2). No significant difference was found in the average duration of pregnancy, average operative hemorrhage volume and operative duration between 2 management groups of curettage after UAE or pure curettage (P > 0.05). But sac diameter and serum level of β-HCG were obviously less in the pure curettage group than those in the UAE group. And the distance between gestation sac and bladder significantly was greater than that in the UAE group; in the pure curettage group, 96.7% existed as an endogenous type and only 36.7% yielded small flow signals. One hundred patients recovered before discharge. A follow-up of patients with curettage after UAE (n = 43) and pure curettage (n = 26) had similar recovery of menstruation. Eight cases (4 in each) were pregnant again during the follow-up. One case of recurrent CSP was treated with curettage after methotrexate.

Early diagnosis and early treatment remain the key for a successful treatment of CSP. Color Doppler ultrasound is important in its early diagnosis and treatment. Different therapeutic modalities may be selected according to specific patient conditions.