title: Transvaginal hysterotomy for cesarean scar pregnancy in 40 consecutive cases.
abstract: To propose a novel procedure as a safe and effective treatment for cesarean scar pregnancy (CSP), a cohort study was initiated in patients diagnosed with CSP and treated with transvaginal hysterotomy from December 2009 to March 2013, either as a primary or secondary therapy. All diagnoses were confirmed by both sonography and pathology, either a gestational sac or residual tissue after termination of pregnancy or miscarriage in the cesarean section scar. Basic clinical characteristics and perioperative data were collected and analyzed. A total of 40 patients were included. The mean age was 32.88 ± 4.55 years. The mean size of gestational sacs of the CSP mass at diagnosis was 33.78 ± 13.14 mm. Mean serum β-hCG level at diagnosis was 47379.73 ± 45285.10 IU/L. Mean operative time was 57.25 ± 24.52 min. Mean postoperative hemoglobin drop was 1.635 ± 0.906 g/dL. Complications were one case of bacteremia and two cases of hematoma. Mean hospital stay after surgery was 4.95 ± 2.62 days. Mean serum β-hCG levels decreased by 88.5, 93.5, and 96.5 % at postoperative day 2, 4, and 6, respectively. All patients' β-hCG levels returned to normal range within 1 month after surgery. Transvaginal hysterotomy with removal of ectopic pregnancy tissue and repair of cesarean scar defect is a promising approach to manage CSPs, with a short hospital stay, low postoperative pain, blood loss, and cost.
authors.affiliation: Department of Gynecology & Obstetrics, The First Affiliated Hospital of Sun Yat-sen University, No. 58 2nd Zhongshan Road, Guangzhou, Guangdong Province China.
authors.forename: Zhang
authors.initials: Z
authors.lastname: Huanxiao
authors.affiliation: Department of Gynecology & Obstetrics, The First Affiliated Hospital of Sun Yat-sen University, No. 58 2nd Zhongshan Road, Guangzhou, Guangdong Province China.
authors.forename: Chen
authors.initials: C
authors.lastname: Shuqin
authors.affiliation: Department of Gynecology & Obstetrics, The First Affiliated Hospital of Sun Yat-sen University, No. 58 2nd Zhongshan Road, Guangzhou, Guangdong Province China.
authors.forename: Jiang
authors.initials: J
authors.lastname: Hongye
authors.affiliation: Department of Gynecology & Obstetrics, The First Affiliated Hospital of Sun Yat-sen University, No. 58 2nd Zhongshan Road, Guangzhou, Guangdong Province China.
authors.forename: Xie
authors.initials: X
authors.lastname: Hongzhe
authors.affiliation: Department of Gynecology & Obstetrics, The First Affiliated Hospital of Sun Yat-sen University, No. 58 2nd Zhongshan Road, Guangzhou, Guangdong Province China.
authors.forename: Niu
authors.initials: N
authors.lastname: Gang
authors.affiliation: Department of Gynecology & Obstetrics, The First Affiliated Hospital of Sun Yat-sen University, No. 58 2nd Zhongshan Road, Guangzhou, Guangdong Province China.
authors.forename: Xu
authors.initials: X
authors.lastname: Chengkang
authors.affiliation: Baylor College of Medicine, Houston, USA.
authors.forename: Guan
authors.initials: G
authors.lastname: Xiaoming
authors.affiliation: Department of Gynecology & Obstetrics, The First Affiliated Hospital of Sun Yat-sen University, No. 58 2nd Zhongshan Road, Guangzhou, Guangdong Province China.
authors.forename: Yao
authors.initials: Y
authors.lastname: Shuzhong
keywords: Cesarean scar pregnancy; Transvaginal hysterotomy; Treatment