Abstract Objective: To investigate the prevention and treatment methods for treating massive bleeding of women with caesarean scar pregnancy (CSP) during or after abortion, and to analyze their prognosis. Methods: The clinical data of 102 women with CSP who had bleeding during or after abortion from January 2010 to May 2018 were analyzed retrospectively. And the clinical treatment methods and prognosis of these included women were analyzed. Results: In the 102 women, 36 women with massive bleeding were in group A, and 66 women with less amount bleeding were in group B. The gestational weeks, the proportion of more than 8 gestational weeks, the proportion of uterine diameter or mass diameter > 60 mm, and uterine scar thickness of women had significant different between the two groups (P<0.05). Logistic regression analysis showed more than gestational weeks and mass diameter >60 mm were independent risk factors for massive bleeding. In group A, 3 women had experinced total or subtotal hysterectomy for treating bleeding, 5 women had experinced uterine cavity tamponade, and 25 women had experinced uterine artery embolization (UAE) (5 women treated by UAE only, 8 women treated by UAE combined with MTX, 8 women treated by UAE combined with curettage through hysteroscopy or ultrasound guidance, 7 women treated by UAE combined with transabdominal scar pregnancy clearance and repair). In group B, 31 women treated by conservative treatment (MTX combined with MF), 35 women treated by surgery (19 women treated by curettage through hysteroscopy or ultrasound guidance, and 16 women treated by transabdominal scar pregnancy clearance and repair). All women had hemostasis successfully, and the hemostasis time and recovery time of women treated by surgical were shorter than those of women by conservative treatment. Conclusion: Women with history cesarean section should beware CSP and massive bleeding after abortion. UAE used for hemostasis can emergency treating vaginal bleeding effectively, and drug combination therapy is necessary. Conservative surgery or transabdominal scar pregnancy clearance and repair is also as a complementary treatment method.
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