Treatments for cesarean scar pregnancy: 11-year experience at a medical center

Figures & data

Figure 1. Treatment options for CSP patients at Shandong Provincial Hospital between 2009 and 2019.

Table 1. Success rates of different treatments for each type of CSP.

	MTX		D&C N (success rate %)	UAE + C N (success rate %)	H + C N (success rate %)	L + H+C N (success rate %)
	Systemic N (success rate %)^a	Systemic and local N (success rate %)^a
Ia	24 (79.2)	9 (88.9)	13 (100.0)	21 (100.0)	32 (100.0)	–
Ib	7 (14.3)	3 (66.7)	13 (100.0)	7 (100.0)	33 (100.0)	–
IIa	25 (52.0)	2 (50.0)	33 (97.0)	128 (100.0)	83 (100.0)	1 (100.0)
IIb	8 (62.5)	2 (100.0)	18 (88.9)	111 (100.0)	51 (100.0)	3 (100.0)
IIIa	1 (0.0)	–	–	13 (100.0)	4 (75.0)	9 (100.0)
IIIb	5 (0.0)	–	3 (0.00)	33 (87.9)	1 (0.0)	29 (96.6)

^a Altogether, the success rate of all medical treatment cases was 59.3% (51/86), and 40.7% of the patients needed secondary surgical intervention.

Table 2. Clinical information and outcomes of type II CSP treated with UAE + C and H + C.

Parameters	UAE + C (n = 239)	H + C (n = 134)	p Value
Maternal age (years)	32.9 ± 4.4	33.9 ± 4.7	.070
Cesarean frequency	1.4 ± 0.5	1.6 ± 0.6	.001
Interval since last cesarean (months)	64.0 ± 44.1	60.0 ± 41.6	.464
Gestational age (days)	53.3 ± 12.1	50.8 ± 11.6	.028
Gestational sac diameter (cm)	3.2 ± 1.5	3.0 ± 1.3	.281
Myometrium thickness (cm)	0.17 ± 0.09	0.19 ± 0.09	.037
Pretreatment serum β-hCG level (mIU/mL)	42,890 (4005–188,723)	26255.7 (2146–182,744)	.000
Post-treatment reduction of β-hCG (%)	87.0 ± 9.5	83.2 ± 8.3	.000
Blood losses (mL)	30 (10–800)	22 (5–450)	.009
Patient need blood transfusion (n, %)	2 (0.8)	1 (0.7)	1.000
Hospitalization time (days)	5.8 ± 3.0	3.6 ± 1.6	.000
Success rate (%)	100.0	100.0	1.000

UAE + C: curettage after uterine artery embolization; H + C: hysteroscopic curettage.

Table 3. Clinical information and outcomes of type IIIb CSP treated with UAE + C and L + H+C.

Parameters	UAE + C (n = 33)	L + H+C (n = 29)	p Value
Maternal age (years)	32.7 ± 5.1	33.7 ± 4.6	.440
Cesarean frequency	1.4 ± 0.5	1.6 ± 0.6	.154
Interval since last cesarean (months)	69.0 ± 53.2	67.9 ± 49.7	.821
Gestational age (days)	67.9 ± 16.9	62.5 ± 14.3	.182
Gestational sac diameter (cm)	5.3 ± 1.5	4.9 ± 1.4	.294
Myometrium thickness (cm)	0.03 ± 0.03	0.06 ± 0.06	.008
Pretreatment serum β-hCG level (mIU/mL)	45,320 (4068–184,631)	87,084 (22,315–278,119)	.003
Post-treatment reduction of β-hCG (%)	85.5 ± 11.6	91.8 ± 5.6	.012
Blood losses (mL)	30 (5–2000)	100 (20–2500)	.040
Patient need blood transfusion (n, %)	6 (18.2)	3 (10.3)	.483
Hospitalization time (days)	7.5 ± 3.8	6.9 ± 2.8	.538
Success rate (%)	87.9	96.5	.360

UAE + C: curettage after uterine artery embolization; L + H+C: laparoscopy combined with hysteroscopic curettage.

Figure 2. Suggested management strategy of CSP.