| BackgroundCaesarean scar pregnancy(CSP)is an iatrogenic disease that the placenta implants within the myometrium and fibrous tissues in a previous scar on the uterus.With the caesarean section rates increasing and progress of diagnostic technologies,especially after the "Two-Child Policy" was carried out,the incidence of caesarean scar pregnancy increased gradually.But due to lack of relevant experience,the optimal therapeutic method of caesarean scar pregnancy remains to be determined now.Generally,termination of pregnancy as soon as possible once diagnosed is strongly recommended.Therapeutic options can be medical,surgical,or a combination of both.In theory,a combined strategy—MTX administration followed by a various surgery would kill the embryo and decrease bleeding.But in our practice,patients who received the combined method have a long hospitalization time,high cost and usually suffer from adverse effects of MTX.With the improvement of gynecological hysteroscopy and laparoscopy technologies,immediate surgery without MTX also get a good prognosis.So,whether it is possible to select a suitable surgical method according to the patient’s condition,and take direct surgical treatment and obtain satisfactory treatment results is worth exploring.ObjectiveTo discuss the necessity of methotrexate pretreatment for surgical treatment of caesarean scar pregnancy.Study DesignThis is a retrospective cohort study.Retrospectively review one hundred and forty-one patients who were diagnosed as caesarean scar pregnancy in the first trimester in Qilu Hospital of Shandong University.According to the our classification aforementioned,the Type I(n=54)refers to the cases whose minimum myometrial thickness of the uterus anterior wall is thicker than 0.3cm.The TypeⅡrefers to the minimum myometrial thickness is 0.1-0.3cm,and gestational sac or mass is smaller than 3cm is TypeⅡ a(n=56),larger than 3cm is Type Ⅱ b(n=11).Type III(n=20)refers to the cases minimum myometrial thickness of the uterus anterior wall is thinner than 0.1cm or discontinuous and the sac or mass was protruding towards the bladder apparently.The same type CSP were further divided into two subgroup according whether receiving MTX pretreatment.Then compare the operative time,blood loss,hospitalization time,hospitalization cost,the time of serum β-hCG level and menstruation became normal between the two subgroups of the same type CSP.Results1)According to our statistics and analysis,two subgroups of each type showed a similar outcome on operation time and intraoperative blood loss(P>0.05).2)Regarding hospitalization cost,immediate surgery subgroups has an obvious advantage for patients of type Ⅰ and Ⅱ a(P<0.05).But no significant difference can be shown between two subgroups of type Ⅱ b and type Ⅲ(P>0.05).3)For hospitalization time,immediate surgery subgroups always has a shorter hospital stays than subgroups with MTX(P<0.05).4)All the patients responded well to the treatment,except one patient of MTX pretreatment group received emergency uterine arterial embolization therapy for massive bleeding after suction curettage under ultrasound guidance,and two patients of immediate surgery group were readmitted and treated with additional medical treatment due to inadequate alteration in blood β-hCG levels and unexpected vaginal bleeding.5)69.81%patients of MTX pretreatment groups and 72.34%patients of immediate surgery groups had a negative serum β-hCG within four weeks after their surgeries(P =0.78).90.57%patients of MTX pretreatment groups and 91.49%patients of immediate surgery groups resumed their menstrual cycles within eight weeks(P =1.00).ConclusionsWe conclude that MTX pretreatment is probably not necessary in the surgical therapy of CSP.It could not remarkably decrease the operation time and intraoperative blood loss and shorten the time of β-hCG and menstrual cycles becoming normal.On the basis of CSP classification,immediate surgery can be recognized as the first-line choice,which has a shorter hospital stays and lower cost. |
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