[Diagnosis and treatment of cesarean scar pregnancy].

OBJECTIVE

To investigate the suitable measures of diagnosis and treatment of cesarean scar pregnancy (CSP).

METHODS

From May 2003 to February 2010, 52 cases were diagnosed as CSP on the basis of the history of cesarean section and the manifestations of pregnancy by transvaginal ultrasound and magnetic resonance imaging (MRI) examination. According to the blood level of β-HCG, 32 patients underwent uterine artery methotrexate perfusion and uterine artery embolization (UAE), 20 cases received a protocol of methotrexate and leucovorin (CF) while UAE or Foley catheter balloon hemostasis was performed for massive vaginal bleeding cases. When β-HCG decreased 80% - 90% and mass blood flow reduced or disappeared, focal resection was administered.

RESULTS

Forty-six cases were diagnosed by transvaginal ultrasound and 6 cases by MRI. On admission, 11 patients with severe vaginal bleeding underwent UAE or Foley catheter hemostasis. Forty patients undergoing curettage had no uterine perforation or rupture with hysteroscopic guidance and laparoscopic monitoring if necessary. Among them, 39 (97.5%) cases were successful. Six cases were directly treated by laparotomy or laparoscopic focal resection and uterine repair. And 6 cases underwent conservative treatment without focal resection. 52 patients were cured successfully without any case of hysterectomy.

CONCLUSION

Transvaginal ultrasound is the preferred diagnostic method of CSP while MRI is an auxiliary method for diagnosis. The treatment of CSP should be based on blood β-HCG levels and lesion location, size, muscle thickness of surface, the condition of blood supply and vaginal bleeding. Different measures may be selected to kill embryos, stop hemorrhage and resect lesions.