Comparison and choice of different treatment modalities for cesarean scar pregnancy

Background: Cesarean Scar Pregnancy (CSP) is caused by implantation of embryonic tissues into the left on uterine tissues left by previous Cesarean section. Severe consequences including uterine rupture and haemorrhage shock is highly likely without timely termination of pregnancy. Various surgical methods have been proposed but lacking a systemic guideline for choice of treatment. This study thus investigated the treatment efficacy and safety of various methods targeting CSP in a retrospective case study manner. Methods: A total of 21 CSP patients who were admitted from Jun 2010 to Dec 2014 in our hospital were recruited, including 5 cases receiving Methotrexate (MTX) followed by ultrasound assisted uterine curettage, 10 patients undergoing MTX with ultrasound assisted uterine curettage plus uterine artery embolization (UAE), and 5 patients having MTX+UAE+hysteroscopy assisted lesion resection. Using retrospective manner, we revised clinical parameters including pregnancy mass size, bleeding volume, pre/post-op HCG level and general conditions of patients. Both efficacy and safety of different treatment modalities were analysed and compared. Results: All 21 patients (including one patient refusing UAE or total hysterectomy) had successful treatment without infection, haemorrhage or liver/renal dysfunction. By choosing different methods according to pre-op conditions of patients, all those 20 patients keeping uterus intact had normal menstrual cycles. Conclusion: Different approaches should be selected based on individual conditions of CSP patients to both minimize trauma and to maximize efficacy.