Objective: To discuss the diagnosis and treatment strategy of cesarean scar pregnancy (CSP).
Methods: Forty-two cases of CSP admitted to Peking University First Hospital from Jan. 2003 to Dec. 2008 were analyzed retrospectively, and the clinical characteristics, pelvic Doppler ultrasonography report, management including methotrexate (MTX) therapy, bilateral uterine artery embolism (UAE), curettage and hysterectomy of these 42 women were reviewed. The percentage of human chorionic gonadochopin (hCG) reduction, menstrual period after the treatment of her CSP and recurrent pregnant outcome were also followed.
Results: Among the 42 CSP women, 24 (57%) presented with vaginal bleeding, 3 (7%) with lower abdominal pain. The interval between CSP and the last cesarean scar (CS) was 0.5 - 18.0 years and the average duration of gestation was (60 +/- 18) days. Fourteen cases (33%) were finally diagnosed as CSP in our hospital followed by failure of abortion due to misdiagnosed as early uterine pregnancy in other hospitals; one (2%) was finally diagnosed after hysterectomy due to excessive bleeding during curettage because of suspected hydatidiform mole under color sonography; one was diagnosed by MRI after color sonography; the rest 25 women (60%) were all confirmed by color sonography before management. Treatment of these cases included curettage after UAE (17 cases), curettage after UAE and MTX (13 cases), curettage after MTX only (4 cases), MTX only (4 cases) and others (4 cases). No significant difference was found in the average duration of pregnancy, average reduction of serum level of hCG and the operation time for curettage between the first two management group (P > 0.05). All of the 42 cases fully recovered before discharge and the recovery time of menses was averagely (32 +/- 10) days (10 - 60 days) after curettage and 5 reported reduced menstrual blood volume. Three out of the 42 women were pregnant again during follow-up and 1 delivered by CS at 39 weeks of gestation one year after without any complications or CSP.
Conclusions: CSP is not common and can be easily misdiagnosed and color ultrasound scan is important in its early diagnosis. UAE combined with MTX followed by curettage is an effective treatment of CSP.