Emergency internal iliac artery temporary occlusion after massive hemorrhage during surgery of cesarean scar pregnancy:A case report

BACKGROUND Cesarean scar pregnancy(CSP)is rare but may result in uterine rupture during pregnancy or massive hemorrhage during abortion procedures.Awareness of this condition is increasing,and most patients with CSP are now diagnosed early and can be managed safely.However,some atypical patients are misdiagnosed,and their surgical risks are underestimated,increasing the risk of fatal hemorrhage.CASE SUMMARY A 27-year-old Asian woman visited our institution because of abnormal pregnancy,and she was diagnosed with a hydatidiform mole through transvaginal ultrasound(TVS).Under hysteroscopy,a large amount of placental tissue was found in the scar of the lower uterine segment,and a sudden massive hemorrhage occurred during the removal process.The bilateral internal iliac arteries were temporarily blocked under laparoscopy,and scar resection and repair were rapidly performed.She was discharged in good condition 5 d after the operation.CONCLUSION Although TVS is widely used in the diagnosis of CSP,delays in the diagnosis of atypical CSP remain.Surgical treatment following internal iliac artery temporary occlusion may be an appropriate management method for unanticipated massive hemorrhage during CSP surgery.

Experience in Surgical Coordination of Type III Cesarean Scar Pregnancy Removal with Combined Assistance of Hysteroscopy and Laparoscopy

Objective:This paper aims to summarize the operative nursing coordination essentials of type III cesareans car pregnancy removal.Methods:Six patients were recruited for this study,and the patient’s condition was fully evaluated before the operation.In addition,the personnel,environment,and materials were well prepared before the operation,and the preparation of special intraoperative instruments and equipment was perfected.Results:The operation is successfully performed in all six patients.Each surgery lasted 70 to 120 minutes with an average duration of 90 minutes.Postoperative blood loss was about 100-500 ml.Postoperative recovery was good without complications in all the patients.Conclusion:In summary,laparoscopic removal of gestational tissue from type III cesareans car pregnancy in conjunction with hysteroscopy ensures compete removal of gestational tissue,while avoiding damaging the surrounding organs and tissues,thus greatly avoiding common complications which usually occur during the surgery.Effective surgical coordination is helpful to further improve the success rate of the operation.

Management of Cesarean Scar Pregnancy: A Case Series

Objective To survey effective treatment strategies for cesarean scar pregnancy(CSP). Methods The clinical data of 78 patients diagnosed with CSP from January 2010 to December 2013 were reviewed. Results Among these patients, 17 patients were first treated at our hospital; of them, 2 were misdiagnosed. The other 61 patients were referred from other hospitals; of them, 21 were initially misdiagnosed. There were 9 patients who were treated with laparotomy, 50 patients with curettage after uterine artery embolization(UAE) with or without local methotrexate(MTX) infusion, 10 patients with dilatation and curettage, 6 patients with transvaginal sonographic guided local intragestational MTX injection, and 3 patients with systemic MTX injection. All patients finally recovered. Patients with excessive vaginal hemorrhage underwent either emergency UAE treatment or laparotomy. These two treatments had similar success rates(81.82% vs. 100%, χ2 =0.289, P>0.05). Conclusions The accurate diagnosis of CSP is important. Curettage after UAE with or without local MTX infusion is a safe and effective method.

Clinical Analysis of 45 Cases of Caesarean Scar Pregnancy

Objective To summarize the clinical characteristics of caesarean scar pregnancy and to investigate its treatment.Methods Clinical case records of 45 cases of caesarean scar pregnancy from June 2003 to September 2007 were reviewed. The characteristics and management of cases were analyzed.Results The women＇s average age was 32.8 ± 5.1 years. All cases had amenorrhoea, and 27 cases had vaginal bleeding from spotting to morderate. Seven cases were misdiagnosed as normal early intrauterine pregnancy or inevitable miscarriage before dilation and curettage（D ＆ C）. In case of massive bleeding, caesarean scar pregnancy was diagnosed after D ＆ C. Bleeding was controlled and uterus was conserved in 6 cases, and 1 case underwent hysterectomy because of uncontrollable bleeding. The remaining 38 cases had ultrasound scan, which indicated scar pregnancy before primary treatment, Eight cases were primarily treated with dilation and curettage, in which only 2 cases had slight bleeding in the operation and no further treatment, Nineteen cases were primarily treated with dilation and curettage after uterine artery embolization, in which 17 cases needed no further treatment and had no complications. The success rate was 89.4% （17/19）. Eleven cases were primarily treated with trichosanthin 1.2 mg intramuscular. No one encountered massive bleeding, but 7 cases of these 11 cases needed extra treatment.Conclusion Caesarean scar pregnancy must be cautious of especially in cases of inevitable miscarriage. Dilation and curettage followed uterine artery embolization can be used as the primary treatment for caesarean scar pregnancy.

Medical Management of Cesarean Scar Pregnancy at Latifa Hospital Dubai Health Authority, Dubai, UAE

Introduction: Cesarean scar pregnancy (CSP) is defined as implantation of gestational sac at the site of cesarean scar. It’s a serious diagnosis that has become more prevalent in recent years and related to the increasing rate of cesarean sections reported worldwide. Identifying these cases and treating them is challenging, with no agreed upon universal protocol for successful treatment. We aim to evaluate the success rate and outcome of medical management for Cesarean scar pregnancy. Methods: It was a retrospective descriptive study of all cesarean scar pregnancies managed at fetal medicine unit at Latifa Hospital in Dubai, UAE the main obstetrics & Gynecology tertiary hospital in Dubai Emirate, UAE from 2015 to 2017. Certainly, a set of diagnostic criteria were implemented to confirm the diagnosis of CSP. The cases were then offered our proposed management which is systemic methotrexate injections ± KCL. Follow up made by serial βhcg and ultrasound scan. The data were collected used specified data collection sheet for this purpose then analyzed and presented using statistical package for social sciences (SPSS) version 26. Results: 33 cases of cesarean scar pregnancies are confirmed and medically managed during the study period. The study subjects composed of a group of patients who had a viable CSP and received local KCL injection + systemic methotrexate, a second group who had non-viable CSP and received systemic methotrexate 20 cases were viable pregnancies who received combined local potassium chloride plus systemic methotrexate, and 13 were non-viable received systemic methotrexate only. The mean gestational age at diagnosis was 8 weeks (SD ± 1.8). On average our cases had a history of 3 previous cesarean sections (range 1 - 6). Overall, the success rate calculated from our study population for medical management of CSP was 77.8%;this varied between viable CSP which had a success rate of 66.7% and non-viable CSP which had a success rate of 100%. The average period of outpatient follow-up for the patients to achieve complete resolution was 14 weeks (SD ± 7.5). Conclusions: Medical management of CSP in the form of systemic methotrexate ± local KCL injections proves to have acceptability and a good success rate especially for non-viable CSP, low complications rate and with the benefit of preserving future fertility.

DIAGNOSIS AND TREATMENT OF CESAREAN SCAR PREGNANCY

Objective To investigate the early diagnosis and treatment of cesarean scar pregnancy(CSP).Methods Clinical data of 28 patients with CSP in Peking Union Medical College Hospital from January 1994 to April 2007,including age,interval from the last cesarean delivery to diagnosis,clinical presentation,location of the lesion,process of diagnosis and treatment,outcome,and follow-up,were retrospectively analyzed.Results CSP constituted 1.05% of all ectopic pregnancies,and the ratio of CSP to pregnancy was 1∶1221.The mean age of the group was 31.4 years.Twenty-six women had only one prior cesarean delivery.The interval from the last cesarean delivery to diagnosis ranged from 4 months to 15 years.The most common presenting symptoms of CSP were amenorrhoea and vaginal bleeding.Seventeen cases were misdiagnosed as early intrauterine pregnancies and 2 were misdiagnosed as gestational trophoblastic tumor.The other 9 were diagnosed definitely before treatment.The diagnosis was made based on cesarean delivery history,gynecologic examination,ultrasound,and magnetic resonance imaging(MRI).The treatment of CSP included systemic or local methotrexate administration,conservative surgery,and hysterectomy.The conservative treatment was successful in 24 cases.All of the 28 women were cured through individual therapies.Conclusions CSP is rare and usually misdiagnosed as other diseases.Ultrasound is valuable for diagnosing CSP,and MRI can be used as an adjunct to ultrasound scan.Early diagnosis offers the options of conservative treatment and greatly improves the outcome of patients.Individual therapy is strongly recommended.

Management of heterotopic cesarean scar pregnancy with preservation of intrauterine pregnancy:A case report

BACKGROUND Heterotopic cesarean scar pregnancy(HCSP)is very rare and has a high risk of massive uterine bleeding.Preservation of concurrent intrauterine pregnancy(IUP)is one of the great challenges in the management of HCSP.No universal treatment protocol has been established when IUP is desired to be preserved.CASE SUMMARY We report a case of HCSP at 8+wk gestation in a 34-year-old woman with stable hemodynamics.A two-step intervention was applied.Selective embryo aspiration was performed first,and surgical removal of ectopic gestational tissue by suction and curettage was performed 2 d later.Both steps were performed under ultrasound guidance.The patient had an uneventful course,and a healthy baby was delivered at 34+6 wk gestation.CONCLUSION Selective embryo aspiration followed by suction and curettage was successful in the preservation of IUP in the management of HCSP.This approach is an alternative option for HCSP in the first trimester when the IUP is desired to be preserved.

Cesarean Scar Pregnancy: A Report of 11 Cases and Review of the Literature Regarding Subsequent Pregnancy

Background: There is no consensus regarding the optimal treatment for cesarean scar pregnancy (CSP) because treatment efficacy, safety, and the influence on subsequent pregnancy must be taken into consideration. Here we report our experience with 11 cases of CSP and review the literature regarding subsequent pregnancy. Methods: Records of 11 CSP cases that were treated at our hospital were retrospectively reviewed. CSP was treated by local methotrexate (MTX) injection or laparotomic or laparoscopic removal of the gestational mass and myometrial repair. Outcome of subsequent pregnancy after treatment was followed-up until delivery. Results: Local MTX injection was performed for six cases, laparotomic removal of the gestational mass and myometrial repair was performed for two, and laparoscopic removal of the gestational mass and myometrial repair was performed for three. The uterus was preserved in all cases. After CSP treatment, eight pregnancies occurred in five cases, resulting in six live births and two miscarriages. Conclusion: Advantages and disadvantages of various treatment methods for CSP continue to be elucidated. Serum hCG level, location of the gestational mass, thickness of the lower uterine segment at the time of diagnosis, and whether the patient wishes for fertility preservation should be considered when choosing a treatment plan.

The Value of Transvaginal Ultrasound in Clinical Surgical Treatment of Cesarean Scar Pregnancy

The clinical value of transvaginal ultrasound in clinical surgical treatment of cesarean scar pregnancy（CSP） was evaluated. The clinical data of 104 patients with CSP admitted at Tongji Hospital from 2013 to 2016 were collected and analyzed retrospectively, including the patients＇ age, gestational age, the size of gestational sac or uneven mass, the uterine scar thickness, β human chorionic gonadotropin（h CG） levels and so on. Of these 104 cases, 30 cases were subjected to laparotomy, 29 cases to laparoscopy, 27 cases to hysteroscopy, 16 cases to ultrasound-guided uterine curettage, and 2 cases to conservative treatment. The transvaginal ultrasound showed that uterine scar thickness and gestational sac or uneven mass size had significant difference（P〈0.05） among different surgical methods by comparatively analyzing the patients＇ data. It was suggested that transvaginal ultrasound may provide the valuable reference for choosing clinical surgical procedures for CSP.

Cesarean scar pregnancy

Cesarean scar ectopic pregnancy is a consequence of a scar from previous cesarean section.It is rare and is associated with catastrophic complications of early pregnancy.It can occur in women with only one prior cesarean delivery.With increasing rate of cesarean section worldwide,more and more cases are diagnosed and reported.The incidence is likely to rise substantially in the near future.A delay in diagnosis and the treatment can lead to uterine rupture,major haemorrhage,hysterectomy and serious maternal morbidity.Early diagnosis can offer treatment options of avoiding uterine rupture and haemorrhage,thus preserving the uterus and future fertility.Aim of this article is to find the demography,pathophysiology,clinical presentation,most appropriate methods of early diagnosis and management.

The Outcome of 40 Patients Becoming Pregnancy after Conservative Treatment of Cesarean Scar Pregnancy

Background: The rate of uterus is successfully conserved following the treatment of scar pregnancy which is high so pregnancy outcome following caesarean scar ectopics is getting more and more attention. Objectives: To assess pregnancy course and outcome after conservative treatment of cesarean scar pregnancy. Methods: A retrospective case series of 40 patients become pregnancy after conservative treatment of cesarean scar pregnancy by Foley or Methotrexate and aspiration. Patients in present study were treated at Hung Vuong and Tu Du Hospital between 2015 and 2017. A telephone follow-up was conducted after cesarean scar pregnancy (CSP) treatment. The outcomes of these subsequent pregnancies and mode of delivery were all recorded. Results: In 40 pregnancies, there are 22 cases of intrauterine pregnancy with childbirth (55%);all babies were born healthy, with no complications recorded in pregnancy. 12 Women had recurrent scar ectopic (30%). There were 2 abortion cases, 2 cases of ectopic pregnancy, and 2 cases of early miscarriage. Conclusions: Our study shows that reproductive outcomes following treatment of caesarean scar ectopic pregnancies are favourable. The risk of recurrent caesarean scar ectopic pregnancy is a concern.

术前中西医结合药物预处理在CSP患者宫腔镜下妊娠病灶清除术中的应用价值分析

目的探讨术前中西医结合药物预处理在剖宫产术后子宫瘢痕妊娠(CSP)患者宫腔镜下妊娠病灶清除术中的应用价值,为临床治疗提供指导建议。方法回顾性分析72例接受宫腔镜下妊娠病灶清除术治疗的CSP患者的临床资料,随机分为A组(34例)、B组(38例)。B组患者实施子宫动脉化疗栓塞术(UACE)治疗后行宫腔镜下妊娠病灶清除术,术前无药物预处理;A组患者在UACE治疗基础上实施中西医结合药物预处理后行宫腔镜下妊娠病灶清除术。比较两组围术期相关指标[手术时间、术中出血量、输血量、住院天数、治疗费用、术后血清人绒毛膜促性腺激素(β-hCG)、术后血红蛋白(Hb)、甲氨蝶呤应用剂量]。结果A组的手术时间(22.0±10.8)min短于B组的(79.2±22.0)min、治疗费用(10476.5±2003.2)元低于B组的(12960.5±2888.7)元,差异有统计学意义(P<0.05);两组术后血清β-hCG、术后Hb、术中出血量、输血量、甲氨蝶呤应用剂量、住院天数比较,差异均无统计学意义(P>0.05)。两组患者在治疗过程中均未切除子宫,术后均无残留。结论CSP患者应用中西医结合药物进行预处理后再行宫腔镜下妊娠病灶清除术,手术效果显著,且具有手术时间短、治疗费用低的优势。

The Diagnosis and Treatment for a Special Type of Cesarean Scar Pregnancy

Caesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy, and its incidence has been increased due to the increased rate of Cesarean sections performed. A special type of CSP, concealed CSP, was found in the clinical work in our institution. A retrospective review was performed. From September 2011 to June 2014, 208 women were presented with cesarean scar pregnancy by use of transvaginal color Doppler sonography. The medical records were consulted to collect the demographics and pertinent information. Six of them were determined to be concealed CSP. Four women were diagnosed in the first-trimester pregnancy after termination of pregnancy. The initial ultrasound of the other two women displayed that the gestational sacs were located in the lower uterine cavity. Placenta accrete, increta and previa were diagnosed by the following ultrasounds. Concealed CSP is a very unusual form of CSP. Continued pregnancy may be sufficiently evaluated because of subsequently serious complications. Our results indicate that continued pregnancy increases the risk of laparotomy and hysterectomy. Medical abortion in the first-trimester pregnancy should be considered as the optimal choice for the women with prior cesarean sections who want to terminate the gestation.

Clinical observation of hysteroscopic surgery combined with ectopic pregnancy ⅱ decoction and methotrexate in the treatment of cesarean scar pregnancy

Objective:To explore the effectiveness and safety about the treatment of Caesarean Scar Pregnancy combined hysteroscopic surgery with extopic pregnancy Ⅱ decoction and methotrexate(MTX).Methods: A total of 80 cases of CSP patients admitted by our hospital from January 2014 to March 2017 were selected as the subjects. According to the treatment way, the patients were divided into experimental group (n=40) and control group (n=40). The control group was given MTX 50 mg/m2, IM once;and the experimental group was given extopic pregnancy Ⅱ decoction on the basis of the treatment given to the control group;the 8th day hysteroscopic surgery. Routine treatment was given after surgery. Experimental group continued to take extopic pregnancy Ⅱ decoction until monitoring the serum beta-hcg level drops below normal. The general information and curative effect, HCG levels before and after 4, 7 and 11d of treatment;mass diameter before and after 11 d of treatment, menstruation recovery time and the incidence of adverse reactions in 2 groups were observed.Results:After hysteroscopic surgery pretreatment with extopic pregnancy Ⅱ decoction and MTX, HCG levels after 4, 7 and 11d were significantly lower than before, it gradually reduced by time prolonged, and research group was lower than control group, the differences were statistically significant. After treatment with different drugs, the size of pregnancy package in the observation group was significantly smaller than that in the control group. Compared with the control group, the he package block size, beta HCG time and vaginal bleeding time were significantly reduced.Conclusion: It has significant clinical effect of hysteroscopic surgery combined with ectopic pregnancy Ⅱ and MTX in the treatment of CSP. It has worthy of clinical promotion to control the amount of blood, avoid intrauterine adhesion caused by uterine artery embolization and infection et al and reduce burden of the physical and economic of patients.

腹腔镜下妊娠物切除联合宫腔镜探查对CSP患者子宫内膜容受性的影响

目的分析腹腔镜下妊娠物切除联合宫腔镜探查对Ⅲ型剖宫产术后瘢痕妊娠(caeasrean scar pregnancy,CSP)患者子宫内膜容受性的影响。方法选取2020年1月至2022年1月湖州市中心医院收治的95例Ⅲ型CSP患者的临床资料,根据治疗方式不同分为对照组(阴式手术局部切除)47例与观察组(腹腔镜下妊娠物切除联合宫腔镜探查)48例。比较两组患者的术后指标、生理应激指标、子宫内膜容受性指标、子宫内膜血流及内膜回声分型。结果观察组患者的阴道流血、人绒毛膜促性腺激素降至正常、月经恢复正常时间短于对照组(P<0.05);并发症发生率低于对照组(2.08%vs.12.76%)(P<0.05);术后两组患者的皮质醇、C反应蛋白均升高,子宫内膜容积、内膜血管指数、血管血流指数均降低,观察组患者的各指标变化幅度大于对照组(P<0.05);治疗后,两组患者的子宫内膜血流、内膜回声分型比较差异有统计学意义(P<0.05),观察组患者的子宫内膜血流分型以Ⅲ型为主(52.08%),对照组以Ⅱ型为主(38.30%);观察组患者的子宫内膜回声以A型为主(54.17%),对照组以B型为主(40.43%)。结论腹腔镜下妊娠物切除联合宫腔镜探查治疗Ⅲ型CSP患者的效果确切,对子宫内膜容受性损伤小,有利于满足患者后期再孕需求。

Expectant management of cesarean scar pregnancy:a case report and a review of literature

Pregnancy in previous cesarean scar is the rarest form of ectopic pregnancy.Little is known about its natural history and optimal management.All literatures except one reported that the expectant treatments for such patients were unsuccessful or led to complication.This paper presents one case of cesarean scar pregnancy(CSP) with expectant management,and discusses the value of this expectant management.The paper also appears a glimpse of the natural courses of certain cesarean scar pregnancies. A 32-year-old woman with a history of cesarean section presented to our outpatient clinic with amenorrhea and bleeding.Sonography and magnetic resonance imaging(MRI) revealed the diagnosis of CSP without viable gestation sac.The patient opted for expectant treatment.We closely monitored the patient with a detailed plan.The patient had mild bleeding during monitoring and her serumβ-hCG levels dropped quickly to normal range after seven weeks.She was fully recovered with total absorption of the mixed mass in the scar of the anterior wall of uterus. If patient with CSP has no viable gestation sac and serumβ-hCG levels are rapidly decreased,she can be expectantly treated.Such cesarean scar pregnancies may be naturally demised.Patient with CSP should be followed up strictly.Medical or surgical therapy should be considered prior to rupture to remove the gestational sac and retain the patient future fertility.

Local metothrexate treatment of cesarean scar ectopic pregnancy

Myometrial pregnancy developing in a previous caesarean section scar is the rarest of all ectopic pregnancies (EP) and probably one of the most dangerous of all because of the risk of rupture and hemorrhage. The recent recognition of this problem means that diagnosis and management are still in their infancy, and there is no consensus regarding the best management of CSP. Methotrexate (MTX) can be administered systemically or locally, or in both ways, with the aid of ultrasound. Patients diagnosed with caesarean scar pregnancies (CSP) in our clinic underwent transvaginal treatment of ectopic pregnancy. Safe and short treatment under transvaginal ultrasonographic (USG) guidance was performed uneventfully in all cases. The operating time ranged from 5 to 10 minutes with no blood loss. Serum β-hCG (β-subunit of human chorionic gonadotrophin) levels declined to normal levels within a month, and patients were discharged without further complications in two or three hours after the procedure. Our cases show that this treatment is effective, safe, and minimally invasive for patients diagnosed with CSP.

甲氨蝶呤联合UACE在CSP患者妊娠物清除中应用研究

目的:探讨甲氨蝶呤联合子宫动脉化疗栓塞术(UACE)在子宫瘢痕妊娠(CSP)患者妊娠物清除中应用效果。方法:选取2020年5月至2021年12月来我院就诊的CSP患者84例,按照随机数字表法分为观察组和对照组,各42例。对照组患者给予甲氨蝶呤治疗,观察组患者给予甲氨蝶呤联合UACE治疗,比较临床疗效、手术一般情况、妊娠物消失时间和血β-HCG恢复正常时间、卵巢功能指标[卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、孕酮(PROG)]、并发症发生情况。结果:观察组与对照组总有效率分别为97.62%、83.33%,观察组比对照组高(P<0.05)。观察组术中出血量显著少于对照组,住院时间明显比对照组短(P<0.05),而两组手术时间比较差异不明显(P>0.05)。观察组妊娠物消失时间和血β-HCG恢复正常时间显著早于对照组(P<0.05)。术后3、6个月两组不同治疗方式对患者卵巢功能指标影响无显著差异(P>0.05)。观察组与对照组并发症发生率分别为7.14%、11.90%,差异无统计学意义(P>0.05)。结论:甲氨蝶呤联合UACE对CSP患者疗效较好,可有效改善患者症状,减少术中出血量和缩短住院时间,同时有效清除妊娠物,且对卵巢功能影响较小,并发症少。

Caesarean Scar Ectopic Pregnancies—Case Series from a District General Hospital

Caesarean Scar Ectopic Pregnancy (CSEP) is a rare, but potentially catastrophic complication of a previous Caesarean Section (CS) birth. This is a review of 5 cases of CSEP managed in our Early Pregnancy Unit at Watford General Hospital within a 10-month period. Two patients had only one previous CS, whilst 2 had two and the last had 3 previous CS. All our patients presented within the first trimester of pregnancy (range 6 to 11 weeks’ gestation) with light vaginal bleeding;4 of them had associated mild to moderate abdominal pain. All were diagnosed using transvaginal ultrasound scan. Three of our patients were managed surgically by Suction Evacuation under Ultrasound guidance and insertion of a Foley’s catheter prophylactically for tamponade in order to reduce blood loss both intra- and post-operatively. One of our patients had a heterotopic pregnancy with a viable intrauterine pregnancy and a live CSEP. She declined any intervention so she was managed conservatively with weekly Consultant appointments and scans. There was a subsequent demise of the CSEP and she continued with a singleton pregnancy. None of our patients were managed medically. There is no absolute consensus on diagnostic criteria and there is no standard management protocol so each woman should be given all the available information and the opportunity to decide on the management of her pregnancy. The risk of a CSEP in a subsequent pregnancy should be part of the consent process for CS.

米索前列醇配伍甲氨蝶呤对CSP的效果及β-hCG、IL-2、INF-γ的影响

目的探讨米索前列醇配伍甲氨蝶呤治疗剖宫产瘢痕妊娠(CSP)的疗效及对β-人绒毛膜促性腺激素(β-hCG)、白介素-2(IL-2)、γ干扰素(INF-γ)的影响。方法选取2018年1月至2019年6月收治的98例CSP患者,根据随机数字表法分为对照组和观察组,每组48例。对照组接受米索前列醇治疗,观察组接受米索前列醇配伍甲氨蝶呤治疗。比较2组患者临床疗效、引产情况和治疗后血清β-hCG、IL-2、INF-γ水平及不良反应发生率。结果观察组治疗总有效率高于对照组,观察组用药至宫缩时间、宫缩至妊娠物排出时间、住院时间、血清β-hCG转阴时间短于对照组,术中出血量低于对照组,差异均有统计学意义(P<0.05)。治疗后2组患者血清β-hCG水平降低,IL-2、INF-γ水平升高,观察组血清β-hCG水平低于对照组,IL-2、INF-γ水平高于对照组,差异均有统计学意义(P<0.05)。治疗后对照组患者血清E2、FSH、LH水平较治疗前降低(P<0.05),观察组血清E2、FSH、LH水平与治疗前比较差异无统计学意义(P>0.05),观察组治疗后血清E2、FSH、LH水平高于对照组(P<0.05)。治疗后2组患者PI、RI升高,观察组患者PI、RI高于对照组(P<0.05)。2组患者不良反应发生率比较差异无统计学意义(P>0.05)。术后随访2年,观察组不良妊娠事件发生率低于对照组(P<0.05)。结论米索前列醇配伍甲氨蝶呤治疗CSP的疗效显著,能有效促进引产,且不良反应较少,安全性高,其机制可能与促进IL-2、INF-γ分泌有关,且可明显改善子宫动脉血流动力学,有效调控机体性激素水平,改善远期妊娠结局。