Management Of Caesarean Scar Pregnancy: A Meta-analysis

Background: Caesarean scar pregnancy is the rarest form of ectopic pregnancy and has been increasingly diagnosed all over the world.The early and accurate diagnosis with timely management can prevent pregnancy complications such as haemorrhage,uterine rupture and can preserve fertility.At present,no standardized management has been available,although some medical and surgical treatment modalities have been suggested.By evidence-based medicine,therefore,exploring a management which is small trauma,quick recovery,safe and effective for cesarean scar pregnancy has important significance.Objective: Research the treatments of caesarean scar pregnancy,such as uterine artery chemoembolization in combination with curettage and aspiration,methotrexate in conjunction with curettage and aspiration,transvaginal debridement and laparoscopic management,to evaluate the clinical effectiveness of these management options of cesarean scar pregnancy.Methods: According to Systematic Review in Heath Care:Meta-analysis in Context,formulated into and exclusion criteria of this research.We conducted literature in the following databases: Pubmed,Embase,Cochrane Library,Medline,OVID,Web of science,CNKI,Wanfang database,Sino Med and VIP database from January 2012 to December 2016.Meanwhile manual searching was involved in journals of Jilin University Medical Library.After all these procedures,two reviewers accomplished study selection,data extraction and quality assessment.Finally,use Review Manager 5.3 software to complete the Meta-analysis.Results: 19 studies were selected for analysis in terms of into and exclusion criteria.Among the 19 studies,15 reported on uterine artery chemoembolization in combination with curettage and aspiration comparing with methotrexate in conjunction with curettage and aspiration,and 4 reported on transvaginal debridement contrast with laparoscopic management.Among total cases,there were 533 patients treated by uterine artery chemoembolization in combination withcurettage and aspiration,383 patients treated by methotrexate in conjunction with curettage and aspiration,114 patients treated by transvaginal debridement and 125 patients treated by laparoscopic management.The Meta-analysis showed: ?uterine artery chemoembolization in combination with curettage and aspiration comparing with methotrexate in conjunction with curettage and aspiration,the result of cure rate showed:OR=2.5,95%CI(1.43,4.38),Z=3.20,P=0.001,P<0.05.?transvaginal debridement contrast with laparoscopic management,among the included four groups,the result of cure rate showed:RR=1.00,95%CI(0.97,1.03),Z=0.20,P=0.84,P>0.05;blood loss of the operation:SMD=1.17,95%CI(0.82,1.51),Z=6.68,P<0.00001,P<0.05;the result of time of operation:MD=25.23,95%CI(20.08,30.38),Z=9.61,P<0.00001,P<0.05;the return of menses:MD=0.76,95%CI(-0.96,2.48),Z=0.87,P=0.39,P>0.05.Conclusion: ? Uterine artery chemoembolization in combination with curettage and aspiration high cure rate than methotrexate in conjunction with curettage and aspiration.? The curing rate of transvaginal debridement and laparoscopic management had no obvious difference.? The amount of hemorrhage and time of surgery of transvaginal debridement were significantly lower and shorter than those of laparoscopic management.