Clinical analysis of 211 cases of cesarean scar pregnancy

Abstract

Clinical analysis of 211 cases of cesarean scar pregnancy Y. Wang1, F.Y. Luo1, Y.D. Xia1, L. Mei1, L. Xie1, H.X. Liu1 1Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu (China) Summary Objective: To investigate the rational choice of early diagnosis and treatment of cesarean scar pregnancy (CSP). M ethods: The clinical data, including age, gravidity, time to previous cesarean section, first symptom, auxiliary examination, regimen, and therapeutic outcomes, of 211 patients with CSP admitted to Sichuan Provincial People’s Hospital from March 2016 to February 2018 were retrospectively analyzed. Results: Of the 211 patients, 165 patients were first diagnosed with CSP in this hospital, and eight of them (4.85%) were misdiagnosed; 46 patients were referred to thus hospital by physicians in other hospitals, and 21 of them (45.65%) were misdiagnosed. After admission, transvaginal color Doppler sonography was performed with a blood β-human chorionic gonadotropin (β-hCG) study to confirm the diagnosis. According to the surgical approaches, 211 patients were divided into six groups: group A: hysteroscopy group (141 patients), group B: uterine artery embolization (UAE) plus hysteroscopy group (38 patients), group C: hysteroscopy plus laparoscopy group (seven patients), group D: UAE with hysteroscopy plus laparoscopy group (six patients), group E: laparotomy group (12 patients), and group F: uterine evacuation group (seven patients). There were no significant differences in age, number of cesarean sections, time from previous cesarean section, days of the missed period, diameter of the gestational sac, or blood β-hCG levels among the six groups (p > 0.05). However, the cure rate, complication rate, mean intraoperative blood loss, mean operative time, mean length of hospital stay, and mean medical cost were all statistically significant between the six groups (p < 0.05). Conclusions: Women who have a history of cesarean section should be vigilant and undergo a transvaginal ultrasound examination as early as possible to exclude CSP and avoid a missed diagnosis or misdiagnosis. For patients at less than or equal to eight weeks of gestation and with a gestational sac diameter less than or equal to 3.0 cm, hysteroscopy is the preferred treatment that is safe and effective. Hysteroscopy combined with laparoscopy and laparotomy are suitable for patients with a high risk of massive bleeding, for instance, patients with a thin anterior myometrium on which abundant blood flow signals are shown, or should be considered as emergency backup plans for other surgical approaches. UAE can effectively reduce intraoperative blood loss but increases the risk of postoperative complications, length of hospital stay, medical costs, and it is suitable for patients with massive bleeding during or after CSP surgery and in need of emergency hemostasis or for patients with a very high risk of bleeding confirmed by a preoperative assessment. Key words: Cesarean scar pregnancy; Hysteroscopy; Uterine artery embolization; Laparoscopy.