title: Treatment options to terminate persistent cesarean scar pregnancy.
abstract: OBJECTIVE
  Persistent Cesarean scar pregnancy (PCSP) is a rare and special type of Cesarean scar pregnancy (CSP) which is resistant to conservative treatment. The treatment option is challenging. We report a case series to provide indications for further treatment.
  
  
  METHODS
  Ten women diagnosed as having a PCSP, seeking better treatment because of primary treatment failure, were admitted to a gynecologic minimally invasive center. Ultrasound combined with office hysteroscopy was used for preoperative evaluation, and then a further surgical strategy was selected. Clinical data were retrospectively studied.
  
  
  RESULTS
  Among ten PCSP patients, 4 were type I and 6 were type II. In the 4 type I cases, 2 were treated by laparoscopy and the other 2 by hysteroscopy; to stop bleeding in 1 of them, the uterine artery was occluded laparoscopically. All type II cases were successfully treated by laparoscopic excision. The mean operating time was 61.5 min. The mean blood loss was 83.5 ml. No complications occurred except one intraoperative hemorrage.
  
  
  CONCLUSIONS
  Experience from this case series indicates that an individualized surgical plan based on a full preoperative evaluation provides useful information for choosing a suitable treatment for PCSP. Endoscopically guided surgical excision with experienced hands may be considered the most useful treatment.
authors.affiliation: Minimally Invasive Gynecology Center, Beijing Obstetrics and Gynecology Hospital affiliated with the Capital University of Medical Sciences, Beijing, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.forename: Hua
authors.initials: H
authors.lastname: Duan
authors.forename: Jiu-Mei
authors.initials: JM
authors.lastname: Cheng
authors.forename: Yin-Shu
authors.initials: YS
authors.lastname: Guo
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D010535:Laparoscopy; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography