Management of caesarean scar pregnancies using an intrauterine or abdominal approach based on the myometrial thickness between the gestational mass and the bladder wall.

AIM To describe our experience with various interventions for caesarean scar pregnancies (CSPs) based on the myometrial thickness between the gestational mass and the bladder. METHODS All patients were initially administered methotrexate. Then, the appropriate therapies hysteroscopy alone or combined with uterine artery embolization (group A) and direct laparoscopy alone or combined with laparoscopic uterine artery occlusion (group B) was selected based on the myometrial thickness between the gestational mass and the bladder. RESULTS The uteri of all 53 patients with CSPs were conserved; no conversion to laparotomy or blood transfusion was required. Uterine rupture occurred in one case during surgery in group A. The operative time in group B was longer than group A (42 ± 18 vs. 80 ± 33 min; p = 0.022). The two groups were also similar with respect to other characteristics (p > 0.05). CONCLUSION Myometrial thickness should be considered during the management of CSPs. Surgical approaches in the treatment of CSPs using 2-mm boundaries may yield an optimal clinical outcome.