Expectant management of 11 cases of cesarean scar pregnancy

Abstract Objective: To explore the natural courses of 11 patients with cesarean scar pregnancy (CSP) with expectant management. Methods: Eleven patients with CSP who were diagnosed in the first trimester in the Third Affiliated Hospital of Guangzhou Medical University from January 2015 to March 2017 were recruited. All of them received expectant management. Nine pregnancies continued to the third trimester (the third trimester group), and 2 patients were expected to the second trimester (the second trimester group). The gestational age at diagnosis, CSP type, gravidity, parity, miscarriage and previous cesarean section history, gestational weeks at termination, amount of postpartum hemorrhage, prenatal and postnatal hemoglobin levels, pregnancy outcomes and obstetric complications were compared between the two groups. Results: The third trimester group terminated pregnancies between 33(+2) and 36(+5) weeks. The second trimester group terminated in the second trimester because of rupture of uterus (at 17(+2), 17(+3) weeks). There was no statistical difference between the two groups regarding the number of gravidity, parity and previous cesarean section (all P>0.05) . The number of miscarriage in the second trimester group was 4.0±2.8, and in the third trimester group was 1.3±1.1 (P<0.05) . In the third trimester group, 7 cases were CSP typeⅠand 2 cases were CSPⅡ. In the second trimester group, 2 cases were both CSP type Ⅲ. Eleven cases were diagnosed placenta accreta pathologically. There was no maternal death, and 6 cases received hysterectomy (6/11). The amount of postpartum hemorrhage increased remarkably and all neonates survived (pregnancy terminated between 33(+2) and 36(+5) weeks). Conclusion: s For those diagnosed as CSP typeⅠandⅡwho urge to continue pregnancies, it's plausible to have expectant management with fully consent of obstetric hemorrhage, rupture of uterus and hysterectomy and close monitoring in tertiary hospital. The detailed expectant management of CSP is needed further exploration.