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Academy of IRMBR Volume  6, Feburary, 2018
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Management of Cesarean Scar Pregnancy: Analysis of Efficacy of Two Conservative Treatment Methods.

There are many reports concerning safety and efficacy of caesarean scar pregnancy (CSP) treatment but there are still some controversial issues like whether uterine curettage can be carried out after medical treatment, or the best combination treatment with Uterine artery embolization. The aim of this study was to investigate the safety and efficacy of uterine artery chemoembolization (UAE) combined with curettage for the treatment of CSP, compared with mifepristone and misoprostol combined with uterine curettage. A retrospective study of patients attending the First affiliated Hospital of Nanjing Medical University, China, between 1st January 2013 and 31st June, 2017, who were diagnosed with CSP type I (endogenous CSP) on Transvaginal ultrasound. Patients were assigned to 2 groups, patients in group A underwent uterine artery chemoembolization (UAE) with intra-arterial methotrexate (MTX) followed by uterine curettage; patients in group B were administrated mifepristone and misoprostol followed by uterine curettage under hysteroscopic or abdominal ultrasound guidance. In total, 199 patients met the inclusion criteria. The blood loss, time before restoration of normal serum beta human chorionic gonadotropin levels(serum β-HCG) and resolution of CSP mass were significantly higher in patients who were treated with mifepristone and misoprostol combined with dilatation and curettage compared with those treated with UAE combined with dilatation and curettage (P< 0.05). The success rate in group A was 93.5% while group B was 76.1%, complications were higher in group B with 2 subsequent emergency subtotal hysterectomies done. Uterine arterial chemoembolization with intra-arterial MTX combined with curettage is a safe and efficient conservative method of treatment of endogenous CSP. Keywords: Curettage, Endogenous Cesarean Scar Pregnancy (CSP), Methotrexate (MTX), Mifepristone, Misoprostol, Uterine Artery Chemoembolization (UAE).
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