Treatment outcomes of uterine lesion resection versus hysterectomy for cesarean scar pregnancy

Abstract

Treatment outcomes of uterine lesion resection versus hysterectomy for cesarean scar pregnancy X.R. Wang1 , Y.F. Wang2 , S.W. Kang1 , Y. Zhang1,∗ 1Operation Room, Shidao People’s Hospital, Weihai 264308, Shandong Province (P.R. China) 2Department of Obstetrics, Weihai Central Hospital, Weihai 264400, Shandong Province (P.R. China) Summary Objective: To compare the effects of uterine lesion resection (ULR) and hysterectomy on cesarean scar pregnancy (CSP). Materials and Methods: A total of 147 patients admitted from January 2009 to January 2019 and diagnosed as CSP by pathological examination were selected, of whom 105 underwent ULR and 42 received hysterectomy. The gestational age, size of gestational mass, serum βhCG level, previous treatments and clinical outcomes of the two groups were compared. Results: Compared with the hysterectomy group, the ULR group had significantly lower gestational age, size of gestational mass and proportion of persistent CSP (p < 0.05), and significantly higher serum β-hCG level (p = 0.011). The median gestational ages of ULR and hysterectomy groups at termination of pregnancy were 67 d and 83 d, respectively, and their median bleeding volumes were 400 mL and 650 mL, respectively (p < 0.05). In the ULR group, the median bleeding volumes of patients with gestational age of ≥ 10 weeks (n = 48) and < 10 weeks (n = 57) were 500 mL and 300 mL, respectively (p < 0.05). Twenty-one cases (20%, 21/105) were switched to hysterectomy due to emergency CSP during curettage, of whom 6 had uterine perforation and 15 had massive bleeding (200-800 mL). The hysterectomy group all received emergency hysterectomy owing to massive bleeding. The proportions of blood transfusion and emergency CSP in the ULR group were significantly lower than those of the hysterectomy group (p < 0.01). Twenty-one patients (14.29%, 21/147) in the two groups suffered from serious complications. Neither group had bladder injury. Conclusion: ULR was mainly suitable for CSP patients with the gestational age of 9-10 weeks at termination of pregnancy, gestational mass size of 60-90 mm, failed initial treatment but stable hemodynamics. Hysterectomy instead of ULR was safer for patients in critical conditions with the gestational age of > 12 weeks. Key words: Uterine lesion resection; Hysterectomy; Cesarean scar pregnancy