[Clinical study on 39 cases with caesarean scar pregnancy with sonographic mass]

To study the clinical features, differential diagnosis and treatment of caesarean scar pregnancy (CSP) with sonographic mass.

A retrospective analysis was performed on 39 patients of CSP with sonographic mass undergoing treatment in Peking Union Medical College Hospital from 2005 to 2012.14 cases with misdiagnosis of gestational trophoblastic neoplasm, among 4 cases were administered by chemotherapy with methotrexate (MTX) , cisplatin, fluorouracil (5-FU) and dactinomycin. According to treatment methods, 39 cases were divided into five groups: 3 cases in methotrexate, 16 cases in dilation and curettage, 15 cases in excision of CSP lesion via laparoscopy, 6 cases in excision of CSP lesion via laparotomy, and 4 cases in transabdominal hysterectomy (TAH).

(1) Clinical characteristics:the mean age was (33 ± 5) years old.Five patients had undergone two prior caesarean sections. The median interval from the last caesarean delivery to CSP was 4 years. Thirty-five cases presented vaginal bleeding or abnormal serum β-hCG level from 5 cases with medical abortion, 9 cases with artificial abortion and 21 cases with dilation and curettage. The sonography showed cystic-solid or solid mass with mixed echoes in the lower segment of anterior uterine wall, surrounded by peritrophoblastic vasculature.(2) Treatment outcome:diagnosis of gestational trophoblastic neoplasm was suspected or made in 20 patients, four of whom were even treated by chemotherapy. MTX therapy was given to 3 patients, 2 of whom were cured. Dilation and curettages were given to 16 patients, 11 of whom were cured. 8 patients underwent curettage with sonographic guidance after uterine artery embolism, and 8 patients with laparoscopic or hysteroscopic guidance. All of 15 patients underwent excision of CSP lesion via laparoscopy were cured. 4 patients were treated by TAH. (3) Time of in hospital and operation:in laparoscopy group, the average hospitalization days were (3.5 ± 1.6) days, the average operation duration was (54 ± 16) minutes. In laparotomy group, the average hospitalization days were (9.7 ± 5.8) days, and the average surgical duration was (87 ± 15) minutes.It reached significant difference (P < 0.05) .

CSP with sonographic mass was the consequence of continued growth of residual pregnancy mass after incomplete abortion or curettage of CSP with gestation sac. The similar sonographic image might lead to misdiagnosis. Individual therapy was recommended. Excision of CSP lesion via laparoscopy might be the primary option for its advantages in differential diagnosis, caesarean scar defect repair and successful ratio.