Comparison of Three Therapeutic Strategies for Cesarean Scar Pregnancy_West China Medical Journal

Authors：

 GAOYan-yu ^1,2 ,  WEIXiu-qing ²

1. Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Obstetrics, Chengdu Women & Children's Central Hospital, Chengdu, Sichuan 610043, P. R. China;

Corresponding author：

WEIXiu-qing, Email: wangqiang_16@163.com

Keywords：

Cesarean scar pregnancy; Uterine artery chemotherapy; Strangulation embryo sac under ultrasound monitoring; Methotrexate

DOI：

10.7507/1002-0179.20150256

Video：

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Objective To compare the curative effect of three therapeutic strategies for cesarean scar pregnancy (CSP). Methods Between January 2009 and December 2013, 208 patients with CSP underwent intramuscular methotrexate alone (group A, n=72), transvaginal ultrasound monitoring after embryo sac strangulation after injection of methotrexate (group B, n=70) and uterine arterial chemoembolization therapy monitoring after hysteroscopy surgery (group C, n=66). We studied their clinical data retrospectively. The preoperative treatment interval, the hospitalization days, intraoperative bleeding, time of blood β-HCG to normal level and hospitalization costs were compared between the groups. Results The preoperative treatment interval, hospitalization days, intraoperative bleeding, and time of blood β-HCG to normal level of group C were significantly better than those of group A and B (P<0.05), while the hospitalization cost of the three groups were not statistically signficant (P>0.05). Conclusion As a treatment for CSP, uterine artery chemoembolization is a safe and effective method, and it has the advantages of short hospitalization time, less intraoperative bleeding and high fertility preservation. It is worth application in clinical medicine.

Citation： GAOYan-yu, WEIXiu-qing. Comparison of Three Therapeutic Strategies for Cesarean Scar Pregnancy. West China Medical Journal, 2015, 30(5): 895-898. doi: 10.7507/1002-0179.20150256 Copy

1.	Mckenna DA, Poder L, Goldman M, et al. Role of sonography in the recognition, assessment, and treatment of cesarean scar ectopic pregnancies[J]. J Ultrasound Med, 2008, 27(5):779-783.
2.	Litwicka K, Greco E. Caesarean scar pregnancy:a review of management options[J]. Curr Opin Obstet Gynecol, 2011, 23(6):415-421.
3.	Hong SC, Lau MS, Yam PK. Ectopic pregnancy in previous caesarean section scar[J]. Singapore Med J, 2011, 52(6):e115-e117.
4.	谢幸, 苟文丽, 主编. 妇产科学[M]. 北京人民卫生出版社, 2013.
5.	Vial Y, Petignat P, Hohlfeld P. Pregnancy in a cesarean scar[J]. Ultrasound Obstet Gynecol, 2000, 16(6):592-593.
6.	Larsen JV. Solomon MH. Pregnancy in a uterine seasacculus:an unusual cause of postabortal haemorrhage[J]. S Afr Med J, 1978, 53(4):142-143.
7.	Seow KM, Huang LW, Lin YH, et al. Cesarean scar pregnancy:issues in management[J]. Ultras Obstet Gynecol, 2004, 23(3):247-253.
8.	Maymon R, Halperin R, Mendlovic S, et al. Ectopic pregnancies in a caesarean scar:review of the medical approach to an iatrogenic complication[J]. Hum Reprod Update, 2004, 10(6):515-523.
9.	何鑫, 陈薇, 张震宇, 等. 子宫动脉化疗栓塞治疗瘢痕妊娠的Meta分析[J]. 首都医科大学学报, 2013, 34(2):275-281.
10.	Godin PA, Bassil S, Donnez J. An ectopic pregnancy developing in a previous caesarian section scar[J]. Fertil Steril, 1997, 67(2):398-400.
11.	黄丽萍, 梁叆琳, 刘辉. 剖宫产术后子宫瘢痕妊娠的诊治进展[J]. 中华妇幼临床医学杂志:电子版, 2010, 6(2):139-141.
12.	Lam PM, Lo KW, Lau TK. Unsacceasfulmrdical treatment of cesareatsacarectopic pregnancy with systemic methotrexate:areport of two cases[J]. Acta Obstet Cynecol Scand, 2004, 83(1):108.
13.	Zhang B, Jiang ZB, Huang MS, et al. Uterine artery embolization combined with methotrexate in the treatment of cesarean scar pregnancy:results of a case series and review of the literature[J]. J Vasc Interv Radiol, 2012, 23(12):1582-1588.
14.	Wu X, Zhang X, Zhu J, et al. Caesarean scar pregnancy:comparative efficacy and safety of treatment by uterine artery chemoembolization and systemic methotrexate injection[J]. Eur J Obstet Gynecol Reprod Biol, 2012, 161(1):75-79.
15.	Shen L, Tan A, Zhu H, et al. Bilateral uterine artery chemoembolization with methotrexate for cesarean scar pregnancy[J]. Am J Obstet Gynecol, 2012, 207(5):386.e1-386.e6.
16.	Liang F, He J. Methotrexate-based bilateral uterine arterial chemoembolization for treatment of cesarean scar pregnancy[J]. Acta Obstet Gynecol Scand, 2010, 89(12):1592-1594.
17.	Yang XY, Yu H, Li KM, et al. Uterine artery embolisation combined with local methotrexate for treatment of caesarean scar pregnancy[J]. BJOG, 2010, 117(8):990-996.
18.	Zhuang Y, Huang L. Uterine artery embolization compared with methotrexate for the management of pregnancy implanted within a cesarean scar[J]. Am J Obstet Gynecol, 2009, 201(2):152.e1-152.e3.
19.	Kochhar PK, Sarangal M, Gupta U. Conservative management of cesarean scar pregnancy with uterine arteriovenous malformation:a case report[J]. J Reprod Med, 2013, 58(1/2):81-84.
20.	Lian F, Wang Y, Chen W, et al. Uterine artery embolization combined with local methotrexate and systemic methotrexate for treatment of cesarean scar pregnancy with different ultrasonographic pattern[J]. Cardiovasc Intervent Radiol, 2012, 35(2):286-291.

1. Mckenna DA, Poder L, Goldman M, et al. Role of sonography in the recognition, assessment, and treatment of cesarean scar ectopic pregnancies[J]. J Ultrasound Med, 2008, 27(5):779-783.
2. Litwicka K, Greco E. Caesarean scar pregnancy:a review of management options[J]. Curr Opin Obstet Gynecol, 2011, 23(6):415-421.
3. Hong SC, Lau MS, Yam PK. Ectopic pregnancy in previous caesarean section scar[J]. Singapore Med J, 2011, 52(6):e115-e117.
4. 谢幸, 苟文丽, 主编. 妇产科学[M]. 北京人民卫生出版社, 2013.
5. Vial Y, Petignat P, Hohlfeld P. Pregnancy in a cesarean scar[J]. Ultrasound Obstet Gynecol, 2000, 16(6):592-593.
6. Larsen JV. Solomon MH. Pregnancy in a uterine seasacculus:an unusual cause of postabortal haemorrhage[J]. S Afr Med J, 1978, 53(4):142-143.
7. Seow KM, Huang LW, Lin YH, et al. Cesarean scar pregnancy:issues in management[J]. Ultras Obstet Gynecol, 2004, 23(3):247-253.
8. Maymon R, Halperin R, Mendlovic S, et al. Ectopic pregnancies in a caesarean scar:review of the medical approach to an iatrogenic complication[J]. Hum Reprod Update, 2004, 10(6):515-523.
9. 何鑫, 陈薇, 张震宇, 等. 子宫动脉化疗栓塞治疗瘢痕妊娠的Meta分析[J]. 首都医科大学学报, 2013, 34(2):275-281.
10. Godin PA, Bassil S, Donnez J. An ectopic pregnancy developing in a previous caesarian section scar[J]. Fertil Steril, 1997, 67(2):398-400.
11. 黄丽萍, 梁叆琳, 刘辉. 剖宫产术后子宫瘢痕妊娠的诊治进展[J]. 中华妇幼临床医学杂志:电子版, 2010, 6(2):139-141.
12. Lam PM, Lo KW, Lau TK. Unsacceasfulmrdical treatment of cesareatsacarectopic pregnancy with systemic methotrexate:areport of two cases[J]. Acta Obstet Cynecol Scand, 2004, 83(1):108.
13. Zhang B, Jiang ZB, Huang MS, et al. Uterine artery embolization combined with methotrexate in the treatment of cesarean scar pregnancy:results of a case series and review of the literature[J]. J Vasc Interv Radiol, 2012, 23(12):1582-1588.
14. Wu X, Zhang X, Zhu J, et al. Caesarean scar pregnancy:comparative efficacy and safety of treatment by uterine artery chemoembolization and systemic methotrexate injection[J]. Eur J Obstet Gynecol Reprod Biol, 2012, 161(1):75-79.
15. Shen L, Tan A, Zhu H, et al. Bilateral uterine artery chemoembolization with methotrexate for cesarean scar pregnancy[J]. Am J Obstet Gynecol, 2012, 207(5):386.e1-386.e6.
16. Liang F, He J. Methotrexate-based bilateral uterine arterial chemoembolization for treatment of cesarean scar pregnancy[J]. Acta Obstet Gynecol Scand, 2010, 89(12):1592-1594.
17. Yang XY, Yu H, Li KM, et al. Uterine artery embolisation combined with local methotrexate for treatment of caesarean scar pregnancy[J]. BJOG, 2010, 117(8):990-996.
18. Zhuang Y, Huang L. Uterine artery embolization compared with methotrexate for the management of pregnancy implanted within a cesarean scar[J]. Am J Obstet Gynecol, 2009, 201(2):152.e1-152.e3.
19. Kochhar PK, Sarangal M, Gupta U. Conservative management of cesarean scar pregnancy with uterine arteriovenous malformation:a case report[J]. J Reprod Med, 2013, 58(1/2):81-84.
20. Lian F, Wang Y, Chen W, et al. Uterine artery embolization combined with local methotrexate and systemic methotrexate for treatment of cesarean scar pregnancy with different ultrasonographic pattern[J]. Cardiovasc Intervent Radiol, 2012, 35(2):286-291.

West China Medical Journal

Comparison of Three Therapeutic Strategies for Cesarean Scar Pregnancy

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