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Comparison of three treatment strategies for cesarean scar pregnancy

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To explore the optimal treatment for cesarean scar pregnancy.

Method

In total, 86 women diagnosed with a cesarean scar pregnancy were divided into three groups according to treatment. The human chorionic gonadotrophin (hCG) decline percentage, intraoperative blood loss and success rate were analyzed in Group A [combination of uterine arterial embolization (UAE), local methotrexate (MTX) injection and dilation & curettage (D&C)], Group B (combination of UAE and local MTX injection) and Group C (D&C). Then, the best treatment was carefully analyzed, and recommendations were provided.

Results

The success rate was highest in Group A (97.5%) compared with Group B (76%) and Group C (63.15%). The reduction in hCG was greatest in Group A (86.62%, 44.0–99.97%) compared with group B (67.83%, 18.0–98.03%) and Group C (68.21%, 27.0–93.24%). The intraoperative blood loss was lowest in Group A (44.881, 5–200 ml) compared with Group C (224.737, 10–1000 ml). Additionally, we found that the best time to perform D&C in group A depended on the hCG reduction percentage, and a 35% reduction after UAE and local MTX injection could be used as the indicator to perform D&C.

Conclusions

The combination of UAE, local MTX injection and D&C for CSP patients is the optimal treatment strategy. A 35% reduction in hCG after UAE and local MTX injection can be recommended as the indicator to perform D&C.

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Acknowledgements

This study was financially supported by the National Natural Science Foundation of China (No. 81572556) and the Graduate Student Training Innovation Project of Jiangsu Province (JX22013371).

Author contributions

XMJ designed the study. GQL, JC, YPX, JCW, and CCD collected the data. JC and YPX performed the statistical analysis and interpretation. GQL wrote the report. JX, JCW revised the report. All authors reviewed the report and approved the final version.

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Correspondence to Juan Xu or Xuemei Jia.

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We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work, there is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of, the manuscript entitled, “Comparison of three treatment strategies for cesarean scar pregnancy.”

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Liu, G., Wu, J., Cao, J. et al. Comparison of three treatment strategies for cesarean scar pregnancy. Arch Gynecol Obstet 296, 383–389 (2017). https://doi.org/10.1007/s00404-017-4426-5

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  • DOI: https://doi.org/10.1007/s00404-017-4426-5

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