Clinical management of cesarean scar pregnancy due to unsuccessful suction and curettage in 10 cases

Objective To discuss the clinical management of patients with cesarean scar pregnancy (CSP) who received unsuccessful suction and curettage. Methods From January 1, 2010 to January 1, 2015, clinical data about 10 patients with CSP who were admitted to our hospital due to unsuccessful suction and curettage were collected. Of the 10 cases, 1 was intrauterine occupancy, 7 were vaginal bleeding, and 2 experienced massive hemorrhage during operation. Results Uterine artery embolization (UAE) was given to 6 cases prior to surgery, 1 case received UAE and uterine artery methotrexate perfusion, and the other 3 cases had no pretreatment. One case underwent electroexcision of lesion with hysteroscopy plus uterine curettage, 1 case underwent transvaginal focal cleaning assisted with laparoscopy plus repairation of uterus, and 2 cases underwent uterine curettage assisted with laparoscopic. Of the 2 cases with huge lesions, 1 case underwent emergency laparotomy to remove the lesion of CSP plus repairation of uterus, and the other patient underwent laparotomy to resect lesion of CSP with uterus repair and bladder repair. One case underwent ultrasound guided curettage, and 3 cases were treated with resection of CSP lesion plus uterus repair by transvaginal surgery. Four cases experienced intraoperative massive hemorrhage. The results of treatment in all cases were satisfactory with the hospitalization days of 2-19 days and blood HCG returned to normal within 3-23 days. No abnormity in uterine cavity was observed by ultrasonography in 1 month after operation. Conclusion For CSP patients with unsuccessful suction and curettage, pretreatment (UAE or bilateral uterine artery ligation) is necessary to block blood flow of lesion and reduce intraoperative blood loss. Hysteroscopy combined with curettage, transvaginal surgery assisted with laparoscopy, transvaginal surgery and laparotomy can be selected as a treatment for those CSP patients.