Comparative Analysis of the Efficacy of Four Different Surgical Modalities in the Treatment of Cesarean Scar Pregnancy: A Multicenter Retrospective Study

Introduction

This study explored the effects of four different surgical methods in the treatment of cesarean scar pregnancy (CSP).

Methods

In this multicenter retrospective analysis of 359 patients, the surgical indices, the time taken for the serum human chorionic gonadotropin level to return to normal, the recovery time of menstruation, and the incidence of postoperative adverse reactions were comparatively analyzed. The clinical efficacies of various preoperative treatment methods to block the blood supply to CSP tissues and those of four different surgical methods to treat CSP, namely, curettage, hysteroscopic surgery, laparoscopic surgery, and vaginal surgery, were evaluated in this study.

Results

Hysteroscopic pregnancy tissue removal in patients with type I CSP was found to be associated with low cost, rapid postoperative recovery, and a low incidence of postsurgical complications. Among patients with type II–III CSP, the operation success rate (96.97% for type II and 88.46% for type III) in those who underwent uterine artery embolization + curettage was lower than that in patients from the other groups (all 100%). Among patients with type III CSP who underwent transvaginal ligation of the descending uterine artery + hysteroscopic removal of the pregnancy tissues, three patients (12.5%) underwent hysteroscopic surgery under transumbilical single-port laparoscopic surveillance so as to avoid uterine perforation considering that the pregnancy tissue was only 1 mm away from the uterine plasma membrane layer.

Conclusion

Hysteroscopic surgery without pretreatment can be adopted for patients with type I CSP. In contrast, patients with type II and III CSP should be initially pretreated with vascular ligation to prevent intraoperative bleeding, followed by laparoscopic or vaginal surgery.

Trial Registry

Clinical Trial Registry Number ChiCTR2000040357.