A comparative observational study was conducted. We retrospectively analyzed our records from February 2013 to 2015 at Maternal and Child Hospital of Hubei Province, Tongji Medical college, Huazhong University of Science and Technology. 157 cases of CSP patients treated with mifepristone combined with TUSC were enrolled in this study. All patients gave written informed consent form before every procedure which clearly counseled the benefits, the curative effects, and the possible complications, including heavy vaginal bleeding and emergency hysterectomy. The study was approved by the ethics committee of Maternal and Child Hospital of Hubei Province. There were no conflicts of interest.
Patients were diagnosed with CSP relied on prior history of CS, increased β-human chorionic gonadotropin (β-hCG) level, and final postoperative pathological result. Patients were divided into three types according to the classification criteria of The Expert Opinion of Diagnosis and Treatment of Cesarean Scar Pregnancy. There were 96 type I cases (61%), 56 type II cases (36%) and 5 type III cases (3%). The gestational age of patients was less than 12 weeks, without any coagulation disorders, trophoblastic disease and other disorders, and not receiving any treatment prior to admission. The vital signs of patients were stable.
Administration of medicine
In our study, patients were firstly treated with drugs. The method and dose of administration of medicine followed by the previous studies[14,15]. All patients took 50 mg of mifepristone twice daily for 2 days at hospital: one at 10.00 h after breakfast and the other at 22.00 h before sleep, respectively. No patients suffered from uncontrollable vaginal bleeding during treatment.
Transabdominal ultrasound-guided suction and curettage (TUSC)
Suction and curettage under transabdominal ultrasound guidance was carried out as follows: Patients were in lithotomy position, transabdominal ultrasound was used to monitor the performance of the instruments. Firstly, adequately dilated the uterine cervical canal, secondly inserted suction curette along the posterior uterine wall to the uterine cavity, then aspirated the uterine fundus and posterior wall was with relatively higher suction pressure (about 400 mmHg), at last, placed the suction cannula at the gestational sac level to evacuate the conceptus content with lower suction pressure (200–300 mmHg). If bleeding was detected, a Foley catheter (16 or 18 F) was inserted into the uterine cavity and inflated with 10–20 ml of saline placed in the region of the scar under sonographic guidance to compress the site of the bleeding. The Foley catheter was fixed to the leg with traction and uterine tamponade was continued for 24 h.
Successful treatment was defined as disappearance of the CSP image on ultrasonography and with decreasing β-HCG levels, without complications, such as heavy bleeding or the need for hysterotomy and/or hysterectomy. Treatment failure was evidenced by the need for any additional nonsurgical or surgical treatment.
We recorded the clinical data of all these patients, including age, gravidity and parity, gestational days,, results of ultrasound imaging examination (diameter of the gestational sac, thickness of the myometrial layer between the gestational sac and the bladder), the β-hCG level before surgery, the blood loss during surgery, and the β-hCG level 1 day after suction curettage postoperatively. All data were expressed as mean±SD. All patients were discharged from hospital 2 days after suction curettage. Following the approved protocol, the serum β-hCG level was monitored weekly until it returned to normal. The patients were requested to come back to our department for a color Doppler ultrasound examination 1 month after taking suction curettage.
Statistical analysis was performed by GraphPad Prism 5. The continuous data with a normal distribution were presented as means ± standard deviations. One-way analysis of variance (ANOVA) was used for mean comparisons between groups. A P value of <0.05 was considered statistically significant.