title: [Clinical comparison of four treatment methods for cesarean scar pregnancy].
abstract: OBJECTIVE
  To explore the best approach to treatment of cesarean scar pregnancy (CSP).
  
  
  METHODS
  A total of 138 patients with CSP treated between January and December, 2013 were retrospectively analyzed. The patients were treated with conservative drug therapy, direct curettage, uterine curettage after embolization, or open or transvaginal surgery. The amount of blood loss, proportion of patients with blooding loss greater than 50 mL, hospitalization days, and hospitalization expenses were compared among the groups.
  
  
  RESULTS
  The median volume of blood loss was 370 mL in the conservative treatment group, 59 mL in direct curettage group, 67 mL in interventional therapy group, and 1425 mL in the surgical group, and the proportion of patients with blood loss over 50 mL was 76.9%, 38.8%, 27.5%, and 100% in the 4 groups, respectively. The midian hospital stay of the 4 groups was 9.0, 4.0, 6.0 and 10.0 days, with median hospitalization expenses of 12281.0, 3843.5, 14805.0, and 17202.2 RMB Yuan, respectively. All these data were significantly different among the 4 groups (P<0.05).
  
  
  CONCLUSIONS
  Direct curettage surgery should be encouraged for treatment of CSP. Embolization therapy can reduce the risk of bleeding but is associated with potential complications and more costly, and should be performed with caution. Open or trasnvaginal surgery can be considered in difficult cases of CSP, and its combination with interventional therapy is an option to better preserving the uterus.
authors.affiliation: Department of Obstetrics and Gynecology, Hunan Provincial Maternal and Child Healthcare Hospital, Changsha 410008, China. E-mail: 2533477789@qq.com.
authors.forename: Chunli
authors.initials: C
authors.lastname: Lin
authors.forename: Xiangling
authors.initials: X
authors.lastname: Liao
authors.forename: Lan
authors.initials: L
authors.lastname: Nie
authors.forename: Xiaocui
authors.initials: X
authors.lastname: Chen
mesh_terms: D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix / Q000150:complications*; D003475:Curettage; D005260:Female; D006801:Humans; D007902:Length of Stay; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055357:Uterine Artery Embolization; D014599:Uterus / Q000601:surgery