Surgical methods and clinical efficacy of different types of cesarean scar pregnancy / 中国基层医药

ABSTRACT

Objective:To compare surgical methods and clinical efficacy among different types of cesarean scar pregnancy (CSP).Methods:A total of 158 patients with CSP who received treatment in Yuncheng Central Hospital from January 2016 to June 2019 were included in this study. According to Expert Consensus on Diagnosis and Treatment of Cesarean Scar Pregnancy (2016 version), type I CSP was found in 55 patients, type II in 86 patients and type III in 17 patients. These patients were divided into groups A (ultrasound-guided suction curettage), B (uterine artery chemoembolization + ultrasound-guided suction curettage) and C (laparoscopic scar pregnancy lesion resection + scar repair) according to different surgical methods. The amount of intraoperative blood loss, the difference in human chorionic gonadotropin (HCG) level between before and after surgery, the time to postoperative HCG level returning to normal level, menstruation recovery, and re-pregnancy were compared between groups.Results:The amount of intraoperative blood loss in the groups A, B and C was (43.33 ± 72.31) mL, (34.41 ± 17.16) mL, (65.71 ± 70.52) mL, respectively. There was significant difference between groups ( F = 8.51, P = 0.014]. The difference in HCG level between before and after surgery in groups A, B and C was (0.64 ± 0.18), (0.79 ± 0.10), (0.76 ± 0.19), respectively. There was significant difference in the difference in HCG level between groups ( F = 19.21, P < 0.001). There was significant difference in the incidence of postoperative menstrual volume reduction between group B and the other two groups ( χ2 = 6.73, P = 0.003). After surgery, intrauterine pregnancy occurred in 12 patients, including 8 patients in group A (type I CSP in 2 patients, type II CSP in 3 patients, type III CSP in 3 patients), 4 patients in group B (type I CSP in 3 patients, type II CSP in 1 patient). Finally, full-term fetus delivery by cesarean section was performed in 6 patients (4 patients in group A and 2 patients in group B). Conclusion:Uterine artery chemoembolization combined with uterine curettage had less blood loss, during surgery and leads to an obvious decrease in HCG level, but it can result in reduction of menstrual volume. Ultrasound-guided suction curettage is preferred for type I and type II CSP. Balloon compression can be used to stop bleeding if massive bleeding occurs. Laparoscopic scar pregnancy lesion resection plus scar repair is recommended for type III CSP.