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| Clinical outcomes and complications of different surgical procedure for treating women with cesarean scar pregnancy |
| 1.Tengzhou Maternal and Child Health Hospital, Shandong Province, 277599；2. Tengzhou City Central People's Hospital, Shandong Province |
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Abstract Objective: To investigate the clinical outcomes and complications of different surgical procedure for treating women with cesarean scar pregnancy (CSP). Methods: The data of 102 women with CSP from August 30, 2016 to August 30, 2018 were analyzed retrospectively, which included 40 women in group A were treated by uterine artery embolization combined with hysteroscopy lesion resection, 32 women in group B were treated by hysteroscopy lesion resection, and 30 women in group C were treated by laparoscopy lesion resection. The level of surgical related indexes and postoperative complications situation of women in the three groups were analyzed, and the pregnancy outcomes of all women were followed up until May 30, 2019. Results: The diameter of blastocysts of women in group B was significant smaller than that of women in group A or group C. The women in group C had mainly type III CSP, the women in group B had mainly type I CSP, and the women in group A had mainly type II CSP. The operation time, intraoperative blood loss, and total complication rate of women in group C were significant more than those of women in group A and group B (P<0.05). There were no significant different in the duration of postoperative continuous bleeding, the rate of conversion to open surgery, incidence of uterine perforation, the rate of profuse bleeding, and rate of postoperative infection of women among the 3 groups (P>0.05). A total of 60 women had fertility requirements after surgery (22 women in group A, 20 women in group B, and 18 women in group C). The median followup time was 19 months. The natural pregnancy rate of these 60 women was 65.0%, and that of women in group A, B, and C were 15/22, 14/20, and 10/18, respectively, which had no significant difference among the three groups (P>0.05). The incidence of CSP again of all women were 17.9% (7/39), and the incidence of CSP again of women in group A, B, and C were 3/15, 3/14, and 1/10, respectively, which had no significant difference among the three groups (P>0.05). The success rate of delivery of women in group A, B, and C were 9/15, 9/14, and 7/10, respectively, which had no significant difference among the three groups (P>0.05). There was no significant difference in serious adverse perinatal outcomes among the 3 groups. Conclusion: Uterine artery embolization combined with hysteroscopy lesion resection, hysteroscopy lesion resection, and laparoscopy lesion resection for treating women with cesarean scar pregnancy all have high rates of natural pregnancy and success delivery, and also have less adverse perinatal outcomes. Laparoscopy lesion resection for treating women with type III CSP has a higher incidence of complication.
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