The Clinical Analysis Of "Three-Step Therapy" Treatment On 45 Cases With Caesarean Scar Pregnancy

Objectives:Caesarean scar pregnancy(CSP)is a very rare and dangerous form of pregnancy because of an increased risk of rupture and excessive hemorrhage.There is currently no consensus on the treatment.We studied if methotrexate(MTX)therapy followed by hysteroscopy treatment followed by Foley tamponade was a viable treatment for patients with CSP,and to assess the clinical evaluation of "three-step therapy".Methods:Retrospective analysis of the clinical data,the course and results of the treatment,which gathered from 45 CSP patients with the application of "three-step therapy"(methotrexate therapy followed by hysteroscopy treatment and followed by Foley tamponade)in Shandong Province,Jinan Central Hospital,from June 2014 to December 2016.Forty-five patients with CSP in our hospital received oral mifepristone and a single dose of 50mg/m2 MTX by intramuscular injection.The second injection of MTX should only have been given once the value of blood ?-HCG was not significantly decreased.After drug treatment,hysteroscopy treatment was performed to remove the retained products of conception and blood clot(CSP mass)under transabdominal sonography(TAS)guidance.After the hysteroscopy treatment,a Foley catheter balloon was placed into the isthmic portion of cervix.Results:Forty-four subjects were successfully treated and only one subject failed treatment which switched to abdominal scar uterus removal of residual pregnancy and prosthesis.The mean estimated blood loss of all 45 patients was(31.47±51.10)ml.The resolution time of the serum?-HCG was 16.09±6.96(3?28)days.The time to CSP mass disappearance was 10.27±3.53(7?14)days.All the patients showed good recovery of uterine ultrasound examination,menstrual recovery 4-12 weeks after operation.Conclusions:"Three-step therapy"(Methotrexate administration followed by hysteroscopy treatment and followed by Foley tamponade)was an effective and reliable method for the treatment of caesarean scar pregnancy,and it has a certain clinical value.