Management for delayed diagnosis in cesarean scar pregnancy with hemorrhage intra- or postuterine dilation and curettage.

AIM

This study aimed to examine the characteristics, management, and outcomes of delayed diagnosis of cesarean scar pregnancy (CSP) with hemorrhage intra- or postuterine curettage for early pregnancy termination.

METHODS

The retrospective study, cases were identified from the interrogation of the hospital database and clinical data including the success rate of different treatments, vaginal bleeding time, abnormal beta-human chorionic gonadotropin (β-hCG) time, and menstrual recovery time, preservation of uterus were analyzed.

RESULTS

Medical records of 80 confirmed CSP cases with dilation and curettage (D&C) as primary treatment were analyzed; among them, 22 were treated with uterine arterial embolization (UAE) + methotrexate (MTX); 32 with UAE + surgery; 26 with only surgery or resection and repair. Treatment with UAE had less intraoperative blood loss (p < 0.05). UAE + surgery treatment had the highest success rate (96.8%, p < 0.05), the least vaginal bleeding duration after treatment (11.9 ± 9.6 days, p < 0.05), and least β-hCG normalization time (17.4 ±  7.8 days, p < 0.05).

CONCLUSION

UAE + surgery treatment is a favorable and effective option to control massive hemorrhage intra- or post-uterine curettage for early CSP termination.