Journal of Shandong University (Health Sciences) ›› 2021, Vol. 59 ›› Issue (1): 40-44.doi: 10.6040/j.issn.1671-7554.0.2020.1058

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Experience in the treatment of 86 cases of type Ⅲ cesarean scar pregnancy

HUO Suxia1, LIU Wei1, WANG Xin2   

  1. 1. Department of Gynecology;
    2. Department of Ultrasound Diagnosis, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China
  • Published:2021-01-09

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Abstract: Objective To explore the treatment strategy of type Ⅲ cesarean scar pregnancy(CSP). Methods The records of 86 patients with type Ⅲ CSP treated in our hospital in the last decade were retrospectively reviewed. According to the surgical methods, the patients were divided into three groups. Group A(n=30)underwent curettage after uterine artery embolization, group B(n=18)received hysteroscopic curettage, and group C(n=38)received laparoscopy combined with hysteroscopic curettage and uterine scar repair. The gestational age, diameter of gestational sac, myometrium thickness, preoperative serum β-human chorionic gonadotropin(β-hCG)level, intraoperative blood loss, decrease of postoperative serum β-hCG, hospitalization time and success rate were compared among the three groups. The quantitative data involved multiple groups of one-way ANOVA or nonparametric test, and the classified data were analyzed by Chi-square test. Results There were no significant differences in maternal age, cesarean frequency and interval since the last cesarean section among the three groups(P>0.05). Gestational sac diameter was larger in group A and group C than in group B(F=52.196, P<0.001). Myometrium thickness was lower in group A and group C than in group B(H=42.553, P<0.001). Preoperative serum β-hCG was significantly higher in group A and group C than in group B(H=9.173, P=0.010). The other pairwise comparisons had no statistical significance. The median amount of intraoperative blood loss was higher in group C than in group A and group B(H=17.211, P<0.001). The success rate in groups A, B and C was 86.67%, 88.89% and 97.37%, respectively, with no significant difference(χ2=3.072, P=0.190). The mean decrease of postoperative serum β-hCG in group C was the fastest(H=14.238, P=0.001). Conclusion For type Ⅲ CSP with gestational sac or mass ≤3 cm and scar thickness ≥2 mm, hysteroscopic curettage can be selected. For gestational sac or mass >3 cm and scar thickness <2 mm, laparoscopy combined with hysteroscopic curettage is recommended. Uterine artery embolization can be used as a supplementary treatment when massive bleeding occurs after primary treatment instead of a preventive measure before curettage.

Key words: Cesarean scar pregnancy, Surgical treatment, Uterine artery embolization, Hysteroscopy, Laparoscopy, Uterine scar repair

CLC Number: 

  • R714.1
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