The Comparison Of The Different Clinical Treatment Of The Cesarean Scar Pregnancy

OBJECTIVE:Compare the effectiveness of uterine arterial embolization, methotrexate foetal sac local injection, methotrexate systemic medication, transvaginal Cesarean scar pregnancy debridement surgery and myometrium neoplasty in treatment of Cesarean scar pregnancy, discuss the advantages and disadvantages of different clinical procedure, provide the basis for the clinical treatment of Cesarean scar pregnancy.METHODS:352cases of clinical data with Cesarean scar pregnancy were analyzed from September2009to December2013in Tianjin Tianhe Hospital (now Tianjin Hospital) and from October2010to December2013in Central Hospital of Obstetrics&Gynecology of Tianjin, including138cases of UAIE,83cases of methotrexate foetal sac local injection,66cases of methotrexate systemic medication and65cases of transvaginal Cesarean scar pregnancy debridement surgery and myometrium neoplasty. comparing of blood loss simultaneously by curettage, operative time, hospital stay, cost of hospitalization, complications, postoperative bleeding, postoperative β-HCG level and the success rates. Evaluate the estradiol, follicle stimulating hormone levels and ovarian size in UAIE group and methotrexate systemic medication group in3and6months later of treatment.Results:1. The vaginal bleeding period postoperative and hospital stay was shortest in transvaginal surgery group. Serum β-HCG level decrease significantly in transvaginal surgical group, and followed by UAIE group, methotrexate foetal sac local injection and methotrexate systemic medication (F=42.89, P<0.001).2. The operative time and blood loss in UAIE was significantly less than the other three groups, followed by transvaginal surgery (F=20.42, P<0.001). But the operation time was longer in transvaginal surgery group than the others (F=41.75, P＜0.001).3. Hospital costs was highest in UAIE (average13612±2642million), followed by transvaginal surgery, there was no significant difference in methotrexate foetal sac local injection and methotrexate systemic medication (P>0.05).4. The success rate was87.7%,84.10%,66.30%and54.5%in UAIE, transvaginal surgery, methotrexate foetal sac local injection and systemic medication respectively (F=0.12, P=0.73).Conclusion:1. The advantage of uterine arterial embolization including fully block the uterine artery blood flow, high local concentration of methotrexate, significantly reducing intraoperative and postoperative bleeding, and preserve the integrity of the uterus, no significant effect on ovarian function. UAIE is still the preferred treatment of Cesarean scar pregnancy.2. Transvaginal Cesarean scar pregnancy debridement surgery and myometrium neoplasty is a new minimally invasive treatment of CSP. It has many advantages such as complete removal of the lesion, retained women’s reproductive function, shorter hospital stay, faster recovery, shorter postoperative bleeding and serum β-HCG decrease quickly postoperation. This procedure is recommended in CSP treatment.3. The advantage of methotrexate foetal sac local injection monitored by ultrasound including lower cost of hospitalization, simple surgical skills and lower requirement for equipment, but with a long hospital stay, decreased serum β-HCG slowly and long period of vaginal bleeding. It is still a good choice for low-income patients and remote areas.4. The methotrexate systemic medication with lower success rate, longer hospital stay, longer period of vaginal bleeding, serum β-HCG decreased slowly, is not a recommended treatment in CSP therapy.