To explore the clinical value of individualized therapy for caesarean scar pregnancy (CSP).

A retrospective study was conducted in 61 patients with CSP in Yuyao People′s Hospital from March 2010 to February 2013. According to the growth pattern of nidus, the patients were divided into 2 groups, which were endogenic type (type I group) and exogenic type (type II group). And the differences of two groups were compared. According to the serum level of β-HCG, location, size, blood flow and surface myometrial thickness of nidus, and vaginal hemorrhage, the patients were treated respectively with methotrexate (MTX) and leucovorin (CF) or uterine artery chemoembolization (UACE), in order to kill embryo, stop and prevent hemorrhage. If all the above treatment failed, curettage was done using hysteroscope, ultrasound or laparoscope to guide. The curative effects of the lengths of time from killing embryo to curettage (≤7 days or >7 days) were compared.

There were 54 cases in type I group and 7 cases in type II group. In type I and type II group, the percentage of abortion were 11% and 71%, the average diameter of masses were (2.4±1.3) cm and (4.3±1.2) cm, and the myometrial thickness of nidus surface were (2.7±1.0)mm and (1.6±0.5)mm, respectively. Comparing the two groups, χ²=11.445, t=-3.612 and t=2.916; P value were all <0.05. Fifty-four cases were treated with UACE, and 7 cases with MTX plus CF. Forty-four cases were treated with curettage guided by hysteroscope, 6 cases guided by ultrasound and 7 cases guided by hysteroscope and laparoscopy; other 2 cases were managed by excising the nidus trans-abdominally, and the other 2 cases were cured with UACE treatment. Sixty-one cases were all cured without hysterectomy. The length of hospitalization time and β-HCG turning to negative in ≤7 days group were (13±6) days and (18±7) days, while in >7 days group were (27±12) days and (31±11) days, respectively. There were significant differences between the two groups (t=-5.862, -5.486, P value were all <0.05).

Individualized therapy according to the patient′s condition can improve the curative effect and prognosis in CSP patients; and the patients in serious condition should be treated with UACE. The classification of CSP by ultrasound is instructive in choosing a rational operation.