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Comparison of three treatment strategies for cesarean scar pregnancy
Guangquan Liu1, Jiacong Wu2, Jian Cao1
1Department of Obstetrics and Gynecology, Nanjing Maternity and Child Health Care Hospital, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, 123 MoChou Road, Nanjing, 210004, Jiangsu, China.
Purpose:
To explore the optimal treatment for cesarean scar pregnancy.
Method:
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.
Results:
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.
Conclusions:
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.
