Treatment of cesarean scar pregnancy: Comparison between dilation and curettage after uterine artery chemoembolization with laparotomy lesion excision

Abstract

Objective Compare the clinical outcomes of dilation and curettage (D&C) after uterine artery chemoembolization (UACE) and laparotomy lesion excision for treatment of cesarean scar pregnancy. Methods 77 Patients with cesarean scar pregnancy between January 2009 and January 2012 were enrolled for retrospective analyses. The patients were divided into two groups: 22 patients in group A treated by laparotomy lesion excision; group B included 55 patients, who received UACE 24-72 hours before D&C. The main outcome measures were operation time, blood loss, time for β-human chorionic gonadotrophin (β-hCG) to decline to normal values, the duration of hospital stay, rate of secondary treatment, complications and menstrual situation after operation. Results None of the 77 patients received hysterectomy. In group A, 1 patient had to receive uterine artery embolization due to massive hemorrhage. The rate of secondary treatment was 5% in group A. In group B, 1 patient received perforation repair, 1 received laparotomy lesion excision due to active bleeding. Theβ-hCG level persisted in 3 patients, 2 of them received MTX injection and 1 received D&C again. The rate of secondary treatment was 9% in group B. The operation time in group B was less than that in group A (35.35±20.21) min versus (114.45±34.32) min, P <0.01). The mean blood loss in group B was lower than that in group A (52.36±28.04) ml versus (186.53±43.30)ml, P<0.01). The average time for β-hCG to decline to normal had significant different between two groups (15.32±3.21)d in group A versus (24.11±7.32) d in group B, P <0.01). The duration of hospital stay of group B was less than that of group A(13.46±4.87) days versus (19.34±5.72) days, P<0.01). All patients regained normal menstruation within half a year. Conclusions D&C after UACE and laparotomy lesion excision are both safe and effective treatments for CSP. D&C after UACE is minimally invasive, with less operation time, less duration of hospital stay and less blood loss in operation. Especially, UACE could provide remarkable clinic outcomes for the patients with acute vaginal bleeding. Key words: Cesarean scar pregnancy; Dilation and curettage; Uterine artery chemoembolization; Laparotomy lesion excision; Methotrexate.