Necessity of establishing standardized diagnosis and treatment of cesarean scar pregnancy from referring patients

Abstract

Objective To explore the establishment of standardized diagnosis and treatment of cesarean scar pregnancy (CSP). Methods Twenty-eight referring patients treated with CSP at first visit hospital were recruited in this retrospective study. The diagnosis and treatment in both first visit hospital and our hospital were evaluated. Results Eighteen patients were misdiagnosed as intrauterine pregnancy, and were given medical or artificial abortion directly at first visit hospital. Ten of them urgently visited our hospital because of intraoperative or postoperative heavy bleeding. Eight of them visited our hospital because of persistent vaginal bleeding after suction. All these patients were diagnosed CSP with three-dimensional color ultrasound scan and magnetic resonance imaging (MRI) after hospitalization. The patients were improved after medical or surgical treatment. Ten patients were diagnosed as CSP, and given the combination of uterine artery embolization (UAE) and ultrasound-guided dilatation and curettage (D&G) at first visit hospital. They came to visit us because of the significantly reduced menstruation or amenorrhea. All of them were diagnosed as uterine or lower uterine adhension and were given dilatation or hysteroscopic surgery. Conclusion Three-dimensional color ultrasound should be recommended for multiple caesarean section or suspicion of CSP patients. The combination of UAE with surgery should be chosen carefully because of its potential fertility complication. Key words: Cesarean scar pregnancy (CSP); Three-dimensional color ultrasound; Uterine artery embolization (UAE); Methotrexate (MTX); Uterine adhension