title: [Management of cesarean scar pregnancy by hysteroscopy combined with uterine artery embolism].
abstract: OBJECTIVE
  To investigate safety and efficacy of hysteroscopy in treatment of cesarean scar pregnancy (CSP).
  
  
  METHODS
  From Aug. 2003 to Dec. 2011, 33 cases with CSP treated by hysteroscopy guided by transabdominal ultrasound or laparoscopy were studied retrospectively in Women's Hospital, School of Medicine, Zhejiang University. The clinical characteristics including gestational age, myometrial thickness anterior to the CSP, β-hCG level before treatment, success rate, cure rate, operative time, blood loss, time of serum β-hCG resolution and CSP mass clearance, and complication were collected and analyzed.
  
  
  RESULTS
  Median gestational age was 54 days (range, 37 - 140 days). Median level of β-hCG before treatment was 15 000 U/L (range, 3.3 - 151 747 U/L). Mean thickness of anterior myometrium was 3.3 mm. Twenty-nine cases underwent uterine artery embolism (UAE) before hysteroscopy. Pouch in the anterior uterine isthmus with gestation masses implanted were observed in 30 cases (91%, 30/33). CSP masses progressed toward the pouch or uterine cavity in all cases was removed by cutting wire loop electrode combined with curettage. The mean operative time was (34 ± 10) minutes. Both success rate and cure rate were 94% (31/33). Salvage methotrexate (MTX) therapy was administrated in one case. Complication occurred in three cases (9%, 3/33). Both massive hemorrhage rate and hysterectomy rate were performed in two cases (6%, 2/33). No uterine perforation occurred. The mean time of hCG resolution was (22 ± 10) days. The mean time of CSP mass clearance was (21 ± 12) days. Four pregnancies were achieved in four cases: one term pregnancy and three abortions. No recurrent CSP occurred.
  
  
  CONCLUSIONS
  Management of CSP by hysteroscopy combined with UAE is safe and effective.
authors.affiliation: Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China.
authors.forename: Zheng-yun
authors.initials: ZY
authors.lastname: Chen
authors.forename: Xin-mei
authors.initials: XM
authors.lastname: Zhang
authors.forename: Hong
authors.initials: H
authors.lastname: Xu
authors.forename: Jing
authors.initials: J
authors.lastname: Zhang
authors.forename: Xiu-feng
authors.initials: XF
authors.lastname: Huang
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D002921:Cicatrix / Q000150:complications*; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D008727:Methotrexate / Q000627:therapeutic use; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography; D055357:Uterine Artery Embolization; D014592:Uterine Hemorrhage / Q000209:etiology / Q000601:surgery; D014599:Uterus / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery; D055815:Young Adult
chemical_list: D018997:Chorionic Gonadotropin, beta Subunit, Human; D008727:Methotrexate