Cesarean Scar Pregnancy

Osborn, D. A.; Williams, Todd R.; Craig, Brian M.

doi:10.7863/jum.2012.31.9.1449

Cited by 127 publications

(55 citation statements)

References 15 publications

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“…Termination of the diagnosed cases by surgical or medical means may improve the outcomes by allowing preservation of the uterus and future fertility. It is anticipated that delay in treatment of scar pregnancies can lead to uterine rupture, hysterectomy and significant maternal morbidity (11,18). Various medical and surgical treatments have been attempted, however, there is no consensus on the optimal mode of treatment (19).…”

Section: Discussionmentioning

confidence: 99%

Curettage after uterine artery embolization combined with methotrexate treatment for caesarean scar pregnancy

Feng

Chen

et al. 2016

Experimental and Therapeutic Medicine

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In the present study, we evaluated the diagnosis and management modalities of caesarean scar pregnancy (CSP). Thirty patients diagnosed with CSP were retrospectively studied between February, 2010 and February, 2012. Twenty-five patients were offered prophylactic uterine artery embolization (UAE) and methotrexate (MTX) prior to uterine suction curettage. Five cases were referred from other hospitals where the initial management with uterine suction curettage had resulted in uncontrollable massive haemorrhage, 4 of the cases had UAE and one proceeded immediately to hysterectomy. In the 25 patients treated with prophylactic UAE and MTX, 12 had laparoscopy-guided curettage and 13 had ultrasound-guided curettage without complication. The results showed that the 25 patients with CSP, who received prophylactic UAE and MTX prior to uterine curettage, recovered without complications. Five patients referred from other hospitals, where uterine curettage was the primary procedure, had severe complications including uncontrolled vaginal bleeding and uterine rupture. Four of the five patients were treated successfully with emergency UAE and the remaining patient underwent emergency hysterectomy as ultrasound examination detected significant haemorrhage between the uterus and the bladder. Of the 25 patients who received prophylactic UAE combined with MTX, there were no reports of irregular menstruation or serious adverse effects. Notably, the decrease in serum human chorionic gonadotropin (HCG) levels 3 days post-surgery was greater with ultrasound-guided curettage (84.3±5.5%) than with laparoscopy-guided curettage (76.3±10.2%). In summary, the data suggested that prophylactic UAE with MTX followed by ultrasound-guided curettage is the most effective therapeutic approach in CSP.

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Section: Discussionmentioning

confidence: 99%

Curettage after uterine artery embolization combined with methotrexate treatment for caesarean scar pregnancy

Feng

Chen

et al. 2016

Experimental and Therapeutic Medicine

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“…This can explain why such proximity was associated with much more blood loss in the procedure even when UAE had been done. Based on the literature [17,24,25] and our experience of this problem, we tried to evaluate two kinds of situation regarding the distance between the gestational mass and the bladder. The likelihood of a massive haemorrhage was lower when there was a distance of >0.2 cm.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Haemorrhage during Suction Curettage after Uterine Artery Embolization for Treating Caesarean Scar Pregnancy: A Case-Control Study

Zhang

Wang³

2015

Gynecol Obstet Invest

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Aims: To investigate the potential risk factors for haemorrhage during suction curettage after uterine artery embolization (UAE) in the treatment of caesarean scar pregnancy (CSP). Methods: A case-control study was executed including 35 patients with CSP and haemorrhage during suction curettage after UAE and 140 controls without haemorrhage. The data collected included gestational age, the distance between the gestational mass and the bladder, and the volume of vaginal bleeding. Results: Six patients with UAE needed blood transfusions and two had a hysterectomy, while no patient in the control group needed these interventions. Multivariate analysis showed that both gestational age and the distance between the gestational mass and the bladder were associated with haemorrhage in the CSP group. The odds ratio (OR) of gestational age between cases and controls was 1.579 (95% confidence interval [CI] 1.291-1.933), and the OR of the distance between the gestational mass and the bladder was 0.208 (95% CI 0.082-0.531). Conclusion: Increased gestational age might be an important risk factor for haemorrhage during suction curettage after UAE in the treatment of patients with CSP, and a distance of >0.2 cm between the gestational mass and the bladder was protective against haemorrhage.

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“…With the recent change in China's One-Child Policy to a Two-Child Policy, the incidence and detection rate of CSP are rising. Cesarean scar pregnancy incidence has increased from 1 per 2,226 to 1 per 1,800 pregnancies [3], along with an increased rate of cesarean sections and increased knowledge and awareness of diagnostic ultrasound.…”

Section: Introductionmentioning

confidence: 99%

“…However, differentiating between CSP, CP, and threatened miscarriage via diagnostic ultrasound in a low-lying gestation sac is particularly difficult [8][9][10]. Not all cases of CSP and CP present with typical ultrasonic imaging [8].…”

Section: Introductionmentioning

confidence: 99%

Intrauterine ectopic pregnancy — ultrasound typing and treatment

Jiang

Nong

et al. 2020

Ginekol Pol

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Objectives:To analyze the correlation between ultrasound typing and treatment modality of patients with an intrauterine ectopic pregnancy (cervical and cesarean scar). Material and methods:We retrospectively enrolled 65 patients diagnosed with cesarean scar pregnancy (CSP) or cervical pregnancy (CP) between February 2014 and May 2018. The cases were divided into two types according to the ultrasound presentation with a gestational sac (GS, type I) or a heterogeneous mass (HM, type II). Type I was further divided into type Ia (< 8 weeks) and type Ib (≥ 8 weeks); type II was defined as type IIa (with poor or no vascularity) and type IIb (with rich vascularity). Three treatment methods were applied in each group.Results: Of included cases, there were 53 CSP and 12 CP. There was no significant difference between Type I and Type II groups in any variable. The beta human chorionic gonadotropin (β-hCG) level and gestational age of type IIb were significantly higher compared to type IIa (p < 0.05). There was a positive correlation between ultrasound categories and treatment methods (rs = 0.723, p = 0.000). Analysis of CSP cases of initial treatment failure indicated success rate of initial dilation and curettage (D&C) was dependent upon ultrasonic types, mean sac diameter, gestational age, hCG level, and number of cesarean sections. Conclusions:The features of ultrasound imaging might provide an additional reference for the selection of clinical treatment methods.

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Cesarean Scar Pregnancy

Cited by 127 publications

References 15 publications

Curettage after uterine artery embolization combined with methotrexate treatment for caesarean scar pregnancy

Curettage after uterine artery embolization combined with methotrexate treatment for caesarean scar pregnancy

Risk Factors for Haemorrhage during Suction Curettage after Uterine Artery Embolization for Treating Caesarean Scar Pregnancy: A Case-Control Study

Intrauterine ectopic pregnancy — ultrasound typing and treatment

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