title: Efficacy of transvaginal debridement and repair surgery for cesarean scar pregnancy: a cohort study compared with uterine artery embolism.
abstract: OBJECTIVE
  Compared with uterine artery embolism (UAE), we aimed to investigate the efficacy and safety of transvaginal debridement and repair surgery (TDRS) and analyze the association between postoperative recovery and individual related factors.
  
  
  METHODS
  A total of 128 patients diagnosed with cesarean scar pregnancy (CSP) from January 2006 to June 2014 were divided into 2 groups. Group A: 38 cases were treated with UAE. Group B: 90 cases were treated with TDRS, of whom 41 received preoperative chemotherapy.
  
  
  RESULTS
  The failure rate in Group A was 5.3% (2/38) and the 2 cases of secondary vaginal hemorrhage after UAE were cured by hysterectomy and TDRS respectively. All patients were successfully treated in Group B and the postoperative outcomes of the patients who received preoperative chemotherapy showed no statistically differences compared with those who didn't. The hospital stays, serumβ-hCG and menstruation recovery in Group B were significantly shorter than those in Group A (P<0.001). In Group B, there was no significant correlation between serumβ-hCG recovery, menstruation recovery and individual related factors including serumβ-hCG, gestational age and maximum diameter of gestational sac at diagnosis.
  
  
  CONCLUSIONS
  Compared with UAE, TDRS is safer, more effective and with a rapider recovery. As an alternative therapeutic option, its prognosis isn't associated with some individual related factors. Furthermore, preoperative chemotherapy is unnecessary.
authors.affiliation: Gynecology and Obstetrics, The First Affiliated Hospital, Sun Yat-sen University Guangzhou 510080, Guangdong Province, China.
authors.forename: Yu-Qing
authors.initials: YQ
authors.lastname: Chen
authors.affiliation: Zhongshan Medicine School, Sun Yat-sen University Guangzhou 510080, Guangdong Province, China.
authors.forename: Hua-Shan
authors.initials: HS
authors.lastname: Liu
authors.affiliation: Zhongshan Medicine School, Sun Yat-sen University Guangzhou 510080, Guangdong Province, China.
authors.forename: Wen-Xin
authors.initials: WX
authors.lastname: Li
authors.affiliation: Zhongshan Medicine School, Sun Yat-sen University Guangzhou 510080, Guangdong Province, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Deng
authors.affiliation: Zhongshan Medicine School, Sun Yat-sen University Guangzhou 510080, Guangdong Province, China.
authors.forename: Xiao-Wen
authors.initials: XW
authors.lastname: Hu
authors.affiliation: Zhongshan Medicine School, Sun Yat-sen University Guangzhou 510080, Guangdong Province, China.
authors.forename: Pei-Jun
authors.initials: PJ
authors.lastname: Kuang
keywords: Cesarean scar pregnancy; transvaginal surgery; uterine artery embolism