Clinical classification and treatment of cesarean scar pregnancy

Zhang, Hongwen; Huang, Ju; Wu, Xianqing; Fan, Hong; Han, Liang; Gao, Tian

doi:10.1111/jog.13267

Cited by 35 publications

(43 citation statements)

References 21 publications

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“…However, it was difficult to draw firm conclusions based on the 22 cases analyzed. Zhang et al classified CSP into risky and stable types, in which the risky type was further categorized into type I (Ia, Ib, Ic), type II, and type III based on the GS location and remaining myometrial thickness [ 23 ]. This classification was shown to provide a better treatment option for different types of CSP; however, this classification is somewhat complicated for most obstetricians.…”

Section: Introductionmentioning

confidence: 99%

New ultrasound grading system for cesarean scar pregnancy and its implications for management strategies: An observational cohort study

Lin

Hsieh

et al. 2018

PLoS ONE

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A cesarean section pregnancy (CSP) indicated the gestational sac (GS) implanted in the previous cesarean scar. The clinical manifestations of CSP present a wide range of variations, and the optimal management is yet to be defined. We retrospectively enrolled 109 patients with the diagnosis of CSP from our department and categorized them into four grades based on the ultrasound presentation. Grade I CSP indicated the GS embedded in less than one-half thickness of the lower anterior corpus; and grade II CSP represented the GS extended to more than one-half thickness of overlying myometrium. Grade III CSP implied the GS bulged out of the cesarean scar; and grade IV CSP denoted that GS became an amorphous tumor with rich vascularity at the cesarean scar. Seventy-eight women received surgery, and the complication rate was 14.1% (11/78). Linear regression analysis demonstrated a significant association between the invasiveness of the surgery and their ultrasound gradings. The mainstream operation for grade I CSP was transcervical resection, while the majority of grade III and IV patients required hysterotomy or hysterectomy. Another 31 women received chemotherapy with methotrexate as their initial treatment. The success rate for chemotherapy was 61.3%; the remaining patients required further surgery due to persistent CSP or heavy bleeding during or after chemotherapy. Fifteen patients (48.3%) receiving chemotherapy suffered from complications (mostly bleeding). Among them, 7 (22.6%) patients experienced bleeding of more than 1,000 mL, and 9 (29.0%) of these 31 patients required blood transfusions. Our novel ultrasound grading system for CSP may help to communicate between physicians, and determine the optimal surgical strategy. Chemotherapy with methotrexate for CSP is not satisfactory and is associated with a higher rate of complications.

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Section: Introductionmentioning

confidence: 99%

New ultrasound grading system for cesarean scar pregnancy and its implications for management strategies: An observational cohort study

Lin

Hsieh

et al. 2018

PLoS ONE

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“…In the present study, D&C was the primary treatment. Although it was performed in many cases (n = 31, CSP: 54.7%, CP: 16.7%) due to its shorter operation time, shorter hospital stay, and lower hospital cost compared to other therapeutic approaches [23], the initially unsuccessful treatment was most commonly managed with D&C [24]. Our data showed that 88.9% (8/9) of failed cases were performed by D&C. Particularly among them, 87.5% (7/8) of cases were CSP.…”

Section: Successmentioning

confidence: 99%

“…This might be a factor that the success rate of initial treatment of CP was superior to CSP (91.7% vs 84.9%). It was well-known that there were 2 types of CSP, with type 1 growing toward the uterine cavity and type 2 progressing toward the bladder and abdominal cavity [23]. D&C treatment was ideal for type 1 CSP (endogenous CSP) to completely remove the abnormally adherent trophoblastic implantation.…”

Section: Successmentioning

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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“…Most often, when diagnosed in the first trimester, cesarean scar pregnancies are treated with methotrexate or dilation and curettage. Expectant management is possible but it is usually associated with increased incidence of hysterectomy due to placental implantation abnormalities or uterine rupture .…”

Section: Types Of Abnormal Placentationmentioning

confidence: 99%