Abstract

The present study investigated suitable measures for treating cesarean scar pregnancy (CSP) complicated with massive hemorrhage. A total of 14 cases were diagnosed as CSP complicated with massive hemorrhage, and were treated from May 2003 to August 2009. Analyses of various factors related to hemorrhaging were carried out. According to the blood β-human chorionic gonadotropin (HCG) level, hemorrhaging onset time, ectopic pregnancy termination, etc., patients underwent uterine artery methotrexate (MTX) perfusion and uterine artery embolization (UAE), Foley’s catheter uterine cavity compression and a protocol of MTX and leucovorin, or laparoscopic focal resection and uterine repair. There was no significant correlation between the hemorrhage quantity and hemorrhaging onset time, amenorrhea duration, β-HCG level, or ectopic mass size (p > 0.05). Hemorrhaging was promptly stopped, and all 14 patients were successfully cured without any case of intraoperative laparotomy or hysterectomy. Uterine artery MTX perfusion and UAE, Foley’s catheter uterine cavity compression and MTX injection, as well as laparoscopic focal resection and uterine repair are all suitable options for treating CSP complicated with massive hemorrhage based on the specific conditions of the patient.

Key words: Treatment, Cesarean section, scar, pregnancy, hemorrhage.