Comparison of the Efficacy and Safety of Different Surgical Strategies for Patients with Type Ⅱ Cesarean Scar Pregnancy

Objective:To compare the efficacy and safety of four surgical strategies currently used for the management of deep implantation cesarean scar pregnancy(CSP-Ⅱ).Methods:This was a retrospective clinical cohort study,and,in total,131 women diagnosed with CSP-Ⅱ and primarily treated in our hospital were recruited.Women treated using laparoscopy assisted by operative hysteroscopy(LAOH;Group A,n=25),uterine artery embolization(UAE)followed by LAOH(Group B,n=21),ultrasound-guided dilatation and curettage(D&C;Group C,n=24),and UAE followed by D&C(Group D,n=61)were evaluated.Univariate and multiple logistic analyses were performed to identify the risk factors.Results:No statistically significant difference was found in patient age,gestational age,size of lesion,and pretreatment serumβ-human chorionic gonadotropins(β-hCG)level.Operation time was longer(P<0.001)and the success rate was higher(P=0.01)in both Group A and Group B than in Group C and Group D.When the cohort was further analyzed regarding patients with myometrial thickness≤3 mm(n=75,defined as CSP-IIb),a lower rate of perioperative complications(P=0.036)and a higher success rate(P<0.001)remained in Group A(n=15)and Group B(n=15)but not in Group C(n=11)or Group D(n=34).In multiple logistic regression analysis,the risk factors related to lower treatment efficacy for patients with CSP-Ⅱ were thinner myometrial thickness of cesarean scar(CS)(≤3 mm)(odds ratio[OR]=5.470,P=0.062),number of cesarean sections(a2)(OR=8.877,P=0.013),mass protruding into the bladder or abdominal cavity(OR=25.507,P<0.001),and direct D&C modality(OR=38.247,P=0.010).Conclusions:Compared with D&C±UAE,LAOH±UAE showed a higher success rate for patients with CSP-Ⅱ,especially when the zygote was more deeply implanted with a myometrial thickness of CS≤3 mm.CSP-Ⅱ treatment should be individualized on the basis of many risk factors.