Clinical Analysis of 45 Cases of Caesarean Scar Pregnancy

Abstract

Objective To summarize the clinical characteristics of caesarean scar pregnancy and to investigate its treatment. Methods Clinical case records of 45 cases of caesarean scar pregnancy from June 2003 to September 2007 were reviewed. The characteristics and management of cases were analyzed. Results The women's average age was 32.8 ± 5.1 years. All cases had amenorrhoea, and 27 cases had vaginal bleeding from spotting to morderate. Seven cases were misdiagnosed as normal early intrauterine pregnancy or inevitable miscarriage before dilation and curettage(D & C). In case of massive bleeding, caesarean scar pregnancy was diagnosed after D & C. Bleeding was controlled and uterus was conserved in 6 cases, and 1 case underwent hysterectomy because of uncontrollable bleeding. The remaining 38 cases had ultrasound scan, which indicated scar pregnancy before primary treatment. Eight cases were primarily treated with dilation and curettage, in which only 2 cases had slight bleeding in the operation and no further treatment. Nineteen cases were primarily treated with dilation and curettage after uterine artery embolization, in which 17 cases needed no further treatment and had no complications. The success rate was 89.4% (17/19). Eleven cases were primarily treated with trichosanthin 1.2 mg intramuscular. No one encountered massive bleeding, but 7 cases of these 11 cases needed extra treatment. Conclusion Caesarean scar pregnancy must be cautious of, especially in cases of inevitable miscarriage. Dilation and curettage followed uterine artery embolization can be used as the primary treatment for caesarean scar pregnancy.