The Effects Of Different Conservative Treatments On Cesarean Scar Pregnancy

Objective: To learn the clinical course and outcome of cesarean scar pregnancy(CSP) via different conservative treatments, and to provide the basis for the clinical management of this disease.Methods: A retrospective cohort analysis of 124 CSP patients primarily adopting conservative treatment from January 2008 to December 2014. According to the concrete treatment, these patients were divided into three groups. Group A consists of 32 patients, who received methotrexate(MTX) injection via intrauterine and intramuscular ways; Group B consists of 48 patients, who received intramuscular MTX injection and curettage treatment; Group C consists of 44 patients, who received uterine artery chemoembolization and curettage treatment. Demographic characteristics and some parameters representing clinical course of CSP were collected, such as age, menstrual history, reproductive history, vaginal bleeding, ultrasonography inspection results, the serum β-h CG level, return of menses, the stay time and the cost of hospitalization. One-Way ANVOA analysis was used to compare clinical course of each treatment. χ2 test was used to compare the rates of the these treatments.Results:1. Comparison of demographic characteristics and primary conditions: there is no statistically difference among the three groups in age, menopause time, the primary serum β-h CG level, the times of parity, gravidity, abortion and cesarean section, as well as the diameter of gestation sac in primary determination(P > 0.05).2. Comparison of clinical course: there is no statistically difference among the three groups in the time of serum β-h CG recovery to normal level, scar mass disappearance, vaginal bleeding, return of menses, the stay time and the cost of hospitalization. Comparison between two groups :(1) the time of serum β-h CG recovery to normal level, scar mass disappearance and vaginal bleeding: the above values of group B and group C were significantly lower than those of group A(P<0.05), and those of group C were significantly lower than group B(P < 0.05);( 2) the time of menses recovery of group B was significantly shorter than that of group A(P <0.05), and the time of group C was significantly longer than that of group A and B(P <0.05);(3) the stay time of hospitalization of group B and C was significantly shorter than that of group A(P <0.05);(4) the cost of hospitalization of group B and C was significantly higher than that of group A(P <0.05).3. Comparison of treatment outcomes: the success rates of the three groups were 87.50%, 91.67% and 90.91%, with no significant difference among them(P> 0.05); the hysterectomy rate of the three groups were 3.13%, 2.08% and 0.00%, with no significant difference among them(P> 0.05); the cesarean scar pregnancy lesions resection rate of the three groups were 9.37%, 6.25% and 9.09%, with no significant difference among them(P> 0.05).Conclusion:1. The cure rates of the three different conservative treatments are relative high, all exceeding 85%.2. There is no significant difference in cure rate and the rate of returning to operation therapy among the three groups. However, there is significant difference in clinical course. C group has obvious advantages in the time of serum β-h CG recovery to normal level, scar mass disappearance and vaginal bleeding; Those indictors in B group is slightly lower than C group, but relatively easy to operate, and appropriate to carry out.3. These conservative treatments have their own advantages and limitations. They should be chose in clinical treatment according to actual conditions.