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.