[Clinical analysis on hysteroscopic surgery for the treatment of type Ⅱ cesarean scar pregnancy in the first trimester]

Abstract

Objective: To investigate the safety and efficacy of hysterosopic management of type Ⅱ cesarean scar pregnancy (CSP) and the value of prophylactic uterine artery embolization (UAE). Methods: Totally 104 patients with type Ⅱ CSP treated with hysteroscopic surgery at the Women's Hospital, School of Medicine, Zhejiang University, during Jan. 2009 to Jun. 2016 were analyzed retrospectively, 67 patients combined with UAE (UAE group) and 37 patients without combined with UAE (non-UAE group). Laparoscopy or sonography guidance was conducted simultaneously. The following clinical parameters were compared, including: primary cure rate, uterine packing rate, uterine perforation rate, hemoglobin level change, the time for the mass absorption and the return of β-hCG to normal, complications, hospital days and hospital stay cost. Results: Median gestational age, size of mass, thickness of the anterior myometrium and β-hCG level in UAE group versus non-UAE group were 47 versus 47 days, 30 versus 30 mm,2 versus 2 mm, 36 524 versus 32 226 U/L (all P>0.05). Out of 104, 100 patients were managed successfully with hysteroscopic surgery, and 4 patients transformed to laparoscopic or laparotomy surgery. Hysteroscopic surgery was effective in 63 out of 67 patients (94%) in UAE group and 34 out of 37 patients (92%) in non-UAE group (P>0.05). There was no significant differences regarding uterine perforation rate, uterine packing rate, hemoglobin change and recovery time between UAE group and non-UAE group (all P>0.05). The median hospital day was 7 days in UAE group versus 5 days in non-UAE group (P<0.01). The median hospital stay cost was 13 654 yuan in UAE group versus 9 108 yuan in non-UAE group (P<0.01). Serious complication occurred in 4 patients (6%, 4/67) in UAE group and 2 patients (5%, 2/67) in non-UAE group (P=0.906). Conclusions: Hysteroscopic surgery is effective and safe for patients with type Ⅱ CSP in the first trimester with size ≤30 mm in diameter and gestation age<7 weeks. The value of prophylactic UAE is uncertain.

Keywords: Cesarean section; Cicatrix; Hysteroscopy; Pregnancy, ectopic; Retrospective studies; Uterine artery embolization.