The Diagnosis And Treatment Of102Cases With Caesarean Scar Pregnancy

Background Implantation of a gestational sac within a caesarean scar of the lower uterine segment is considered to be a rare form of ectopic pregnancy. Because the trophoblastic cells invade the uterine wall in the first trimester, the myometrial where the pregnancy implanted is sick. Besides there’s no significant characteristic of clinical symptoms of this disease, in this case, a delay in early and accurate diagnosis and treatment can lead to profuse hemorrhage and uterine rupture which is secondary to hysterectomy and maternal future infertility. Over the past decades, the incidence of CSP has risen. Between1January2006and31February2012, the incidence of this disease in QiLu Hospital of Shandong University is1:1077, and a rate of2.44%of all ectopic pregnancy, which has been substantial increase year by year. So far, there’s no consensus on the preferred mode of CSP treatment. This article was calculated to evaluate this condition by analysing clinical data of102cases with CSP.Objective To evaluate the early diagnosis and treatment of caesarean scar pregnancy.Method The retrospective clinical cohort study was designed to compare the clinical outcome of102patients with caesarean scar pregnancy in Qilu Hospital of Shandong University from1January2006to31February2012, including28cases with the muscle injection and intrauterine cavity injection of MTX,61cases with MTX therapy followed by ultrasound-guided suction curettage and13cases with uterine arteries embolization followed by low vacuum aspiration. Results The recovery after three different mode of therapy is descriptive as follows. The mean resolution time of serumβ-hCG and CSP mass were statistically different in three groups (P<0.05), the mean resolution time of serumβ-hCG was45.20±10.31days、29.50±13.39days and26.00±3.89days; the disappearance time of CSP mass was55.60±10.71days,36.70±25.06days and52.00±11.59days. There was no statistically significant difference in the mean recovery time of normal menses (P>0.05). The time of vaginal bleeding were statistically different in three groups (P<0.05):35.36±10.21days,20.01±6.99days,29.53±16.78days. The difference between hospital stays and hospitalization expenses of three groups were significant (P<0.05), the hospital stays was13.96±10.41days,15.79±10.93days,25.33±20.13days, the hospitalization expenses was3865.46±808.68yuan,6381.64±544.28yuan,41815.93±21100.70yuan. The success rate of28cases with the muscle injection and intrauterine cavity injection of MTX is92.86%, compared with88.52%for61cases with MTX therapy followed by ultrasound-guided suction curettage and with84.62%for13cases with uterine arteries embolization followed by low vacuum aspiration. There was no statistically significant difference in the success rate of three groups(P>0.05).Conclusion The incidence of this disease in QiLu Hospital of Shandong University is1:1077, and a rate of2.44%of all ectopic pregnancy, which has been substantial increase year by year. The success rate of systemic combined with local injection of MTX is high, this mode of CSP treatment is simple and easy to do, patients underwent this management needn’t stay in hospital for a long time, and spent less than other management, so this therapy is well worthy adopting in Primary Hospital. Compared with uterine arteries embolization followed by low vacuum aspiration, MTX therapy followed by ultrasound-guided suction curettage has the similar high success rate and was considered as a minimally invasive treatment. Patients received this management stayed shorter time in hospital and spent less than the former.