[Clinical features and outcome of cesarean scar pregnancy].

Objective: To analysis the clinical features of cesarean scar pregnancy (CSP), to evaluate the therapeutic effect of various treatments, especially the feasibility and advantage of Methotrexate (MTX)-Uterine artery embolization (UAE)- Sonogrphy directed-In situs aspiration sequential therapy based on the pregnancy sac three-dimensional conformation analysis (3D-MESIA). Methods: From January 2007 to December 2014, 99 subjects who were diagnosed as CSP in Chaoyang Hospital of Capital Medical University were studied retrospectively. According to different treatment, they were divided into six groups: 51 cases treated by 3D-MESIA (group A), 8 cases treated by systemic MTX injection (group B), 9 cases treated by uterine artery chemoembolization or uterine artery embolization combined with systemic MTX injection (group C), 10 cases treated by uterine curettage after systemic MTX injection (group D), 11 cases treated by uterine curettage after uterine artery embolization (group E), 10 cases treated by uterine curettage directly (group F). Each group according to the CSP classification can be divided into two subgroups: endogenous CSP and exogenous CSP. The intraoperative blood loss, operative time, β-hCG clearance time, lesion absorption time, hospitalization time, hospitalization expenses, the success rate were compared among the six groups and two subgroups. Results: (1) The operative time and blood loss of endogenous CSP had no significant difference in different operative methods ( P >0.05). β-hCG clearance time and lesion absorption time of endogenous CSP in group B were significantly longer than the other five groups ( P <0.05). (2) The intraoperative blood loss in group A and group E compared with group D and group F was decreased significantly ( P <0.05). β-hCG clearance time and lesion absorption time of exogenous CSP in group A were significantly shorter than those in the other five groups ( P <0.05). (3) The hospitalization time in group E and group F were obviously shorter than that in other groups ( P <0.05). The hospitalization expense in group B and group F were obviously less than that in other groups ( P <0.05). (4) The success rate of endogenous CSP in group F was the lowest, but the difference had no significant statistical significance ( P >0.05). The success rate of exogenous CSP in group A and group E were obviously higher than that of the other four groups ( P <0.05). Conclusion: The treatment effect of MTX therapy alone or uterine artery embolization for CSP is poor. 3D-MESIA is safe and effective for endogenous CSP. It is easy to promote and can be used as the initial treatment of exogenous CSP. If it fails, the laparoscopic removal of lesions and scar repair could be the remedial measure.