A Comparison of Treatment Options for Type 1 and Type 2 Caesarean Scar Pregnancy: A Retrospective Case Series Study

Shen, Feng; Lv, Hongdao; Wang, Liming; Zhao, Ruiheng; Tong, Mancy; Lee, Arier; Guo, Fang; Chen, Qi

doi:10.3389/fmed.2021.671035

Cited by 9 publications

(5 citation statements)

References 19 publications

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“…Until now, there have been few studies on the treatment of CSP according to its classification. Our previous research shows that hysteroscopy-assisted laparoscopy is safe and effective for type 2 CSP (Qi et al, 2019), which has been confirmed by other similar studies (Wang et al, 2014;Shen et al, 2021). As the gestational sac is implanted on the scar and grows toward the uterine cavity, the risk of type 1 CSP is relatively lower, therefore, we evaluate the treatment of type 1 CSP based on the therapeutic effect and health economics.…”

Section: Discussionsupporting

confidence: 67%

The Efficacy and Health Economics of Different Treatments for Type 1 Cesarean Scar Pregnancy

et al. 2022

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Objectives: To evaluate the efficacy and health economics of four treatments for type 1 cesarean scar pregnancy (CSP).Methods: From January 2009 to December 2018, 326 patients diagnosed with type 1 CSP were examined, among whom 31 received ultrasound-guided local injection of methotrexate (local injection group), 160 patients received uterine artery embolization combined with suction aspiration (UAE group), 25 patients received ultrasound-guided suction aspiration (aspiration group) and 90 received ultrasound-guided local injection of lauromacrogol combined with suction aspiration (lauromacrogol group). Clinical data and outcomes were analyzed. The decision tree model was used to compare the economics of four treatments.Results: The success rate of the local injection group was 71.0% (22/31), which was significantly different from 98.8% (158/160) of the UAE group and 100.0% (90/90) of the lauromacrogol group. The success rate of the aspiration group was 92.0% (23/25), which was significantly lower than that of the lauromacrogol group. The cost-effectiveness ratio was 1,876.53 yuan for the aspiration group, 2,164.63 yuan for the lauromacrogol group, 4,383.56 yuan for the local injection group, and 7,850.81 yuan for the UAE group. The Incremental cost effectiveness ratio (ICER) of the lauromacrogol group to the aspiration group was 5,477.75 yuan, indicating that if the willing to pay of patients was higher than 5,477.75 yuan, the lauromacrogol group had a cost-effectiveness advantage in treating type 1 CSP, compared to aspiration group. On the contrary, aspiration group has a higher cost-effectiveness advantage. The ICER of the lauromacrogol group to the local injection group or the UAE group were both less than 0, indicating that local injection group and UAE group was not cost-effective in the treatment of type 1 CSP.Conclusion: For type 1 CSP, the ultrasound-guided local injection of lauromacrogol combined with suction aspiration and ultrasound-guided suction aspiration, are effective and economical, and the choice between the two can be based on the patient’s willing to pay.

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Section: Discussionsupporting

confidence: 67%

The Efficacy and Health Economics of Different Treatments for Type 1 Cesarean Scar Pregnancy

et al. 2022

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“…For type II a and type III b CSP, operative resection is deemed appropriate. Numerous studies have demonstrated the efficacy of laparoscopic hysterotomy with wedge resection of the previous scar, thus warranting its recommendation [ 27 , 28 ]. In a review study, laparoscopy demonstrated a success rate of 97% with expedited resolution of HCG levels and absence of complications [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Systematic evaluation of the efficacy of treatments for cesarean scar pregnancy

Sun,

Wang,

et al. 2024

Reprod Biol Endocrinol

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Study objective Cesarean scar pregnancy (CSP) is a type of ectopic pregnancy associated with severe complications, including significant hemorrhage, the potential need for hysterectomy, and life-threatening risks. Currently, two classification methods exist for CSP: Vial (type Ia and IIa) and Chinese Expert’s Consensus (type Ib, type IIb, and type IIIb). However, these methods have limitations in guiding the selection of appropriate treatment plans for CSP. The purpose of this study was to systematically evaluate the effectiveness of various treatments for CSP within our clinic. Method Our study included 906 patients with CSP from January 2013 to December 2018. The chi-squared test and logistic analysis were used to compare the clinical characteristics. The median and interquartile range (IQR) was calculated. We also analyzed whether preoperative application of methotrexate (MTX) could improve surgical outcomes and the relevant characteristics of misdiagnosed CSP patients. Results There was a significant difference in gestational age, gestational sac diameter, gestational sac width, gestational sac area, remnant myometrial thickness, vaginal bleeding and preoperative hemoglobin levels (p < 0.001) but not in the incidence of residual tissue (p = 0.053). The other factors (intraoperative blood loss, hemoglobin decline, first hemoglobin after operation, total hospital stay, hospital stay after operation, transfusion and duration of catheter drain) were significantly different (p < 0.001). For type Ia and type Ib CSP, 39.3% and 40.2% of patients were treated with dilatation and curettage (D&E) under ultrasound, respectively. For type IIa and type IIIb CSP, 29.9% and 62.7% of patients were treated with laparotomy, respectively. There were no differences in surgical methods, residual tissue and reoperation between the MTX and non-MTX groups (p = 0.20), but liver damage, hospital stay and pain perception were more remarkable in the MTX group. It is noteworthy that 14% of the patients were misdiagnosed with an intrauterine pregnancy. The incidence of misdiagnosis in type IIa CSP patients was higher than that in type Ia CSP patients (p < 0.001). Conclusion For type I CSP patients, D&E under ultrasound or D&E under hysteroscopy should be recommended. For type IIIb CSP patients, operative resection should be used. It is currently difficult to choose the appropriate treatment methods for type IIa or type IIb CSP patients.

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“…It has been reported that more than a half of all CSPs treated with dilation and curettage (D&C) alone required additional treatment [ 10 , 11 ]. However, in another study, treatment with uterine curettage had a 95% success rate in cases of type I CSP, while this treatment only showed 27% success in cases of type II CSP [ 12 ]. The blood supply characteristics of different types of CSP may be different, resulting in different bleeding risks.…”

Section: Introductionmentioning

confidence: 99%

Complex Blood Supply Patterns in Cesarean Scar Pregnancy: Insights from Digital Subtraction Angiography Imaging

Gao

Guo

et al. 2023

Med Sci Monit

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Background Understanding the blood supply pattern of cesarean scar pregnancy (CSP) can effectively help to determine the best choice of treatment. The aim of this study was to investigate the blood supply pattern and outcomes of patients with CSP through digital subtraction angiography (DSA) imaging. Material/Methods This was a retrospective cohort study. Patients were divided into 2 groups according to the type of CSP. The DSA images of these patients were reviewed, including the type of blood supply, dominant vessel, and collateral blood supply to the gestational sac. The clinical outcomes were analyzed between the 2 groups. Results Thirty-seven patients with type I and 29 patients with type II CSP were enrolled in this study. Type II CSP showed a higher proportion of rich blood supply than type I (44.83% vs 29.72%, P >0.05). Compared with type II CSP, type I CSP tended to have bilateral dominant blood supply predominance (67.57% vs 41.38%, P <0.05). The incidence of collateral blood supply was 5.41% in the type I CSP group and 31.03% in the type II CSP group ( P <0.05). In the type II CSP group, multiple collateral blood vessels were found in 4 patients. The superior vesicle artery was the most common source of collateral blood supply in both groups. Two patients with type II CSP suffered massive bleeding during surgery after uterine artery embolization (UAE). None of the patients received a hysterectomy. Conclusions UAE is safe and effective for both types of CSP. The blood supply pattern is more complex and abnormal in type II CSP. More attention should be paid to the collateral blood supply to achieve complete embolization during the UAE procedure in the case of type II CSP.

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A Comparison of Treatment Options for Type 1 and Type 2 Caesarean Scar Pregnancy: A Retrospective Case Series Study

Cited by 9 publications

References 19 publications

The Efficacy and Health Economics of Different Treatments for Type 1 Cesarean Scar Pregnancy

The Efficacy and Health Economics of Different Treatments for Type 1 Cesarean Scar Pregnancy

Systematic evaluation of the efficacy of treatments for cesarean scar pregnancy

Complex Blood Supply Patterns in Cesarean Scar Pregnancy: Insights from Digital Subtraction Angiography Imaging

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