Hysteroscopic treatment and reproductive outcomes in cesarean scar pregnancy: experience at a single institution

Tang, Qin; Qu, Yan; Zhou, Qing; Tang, Junying; Qiao, Jian; Chunmei, Shu; Dai, Xiyong; Zhang, Jing

doi:10.1016/j.fertnstert.2021.06.015

Cited by 19 publications

(13 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this study, 84 patients who had failed in contraception opted for an early abortion. Among the patients who had another pregnancy, 17 cases had a reoccurrence of CSP, and the incidence of RCSP was 10.24%, which is close to that in the Tang study [ 24 ]. Qian's study suggested that lower grade of hospital for the previous cesarean section, thinness of the lower uterine musculature before pregnancy and the presence of combined abdominal pain and vaginal bleeding at the previous CSP were risk factors for the occurrence of RCSP [ 25 ].…”

Section: Discussionsupporting

confidence: 77%

Analysis of pregnancy outcomes following surgical treatment of cesarean scar pregnancy

Sheng

Yang

et al. 2022

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

Purpose To investigate the surgical treatment approaches for patients with Cesarean scar pregnancy (CSP) and the effects on subsequent pregnancy. Methods CSP patients admitted to Shengjing Hospital of China Medical University from January 2013 to December 2018 were retrospectively analyzed to collect their clinical characteristics, and follow-up of postoperative pregnancies. Results A total of 1126 CSP patients were enrolled in this study, including 595 (52.84%) CSP type I, 415 (36.86%) CSP type II, and 116 (10.30%) CSP type III cases. There were significant differences between the three types of patients in terms of β-HCG levels, gestational sac diameter, clinical symptoms and presence of fetal heartbeat at diagnosis (P < 0.01). Among these, 89.90% of CSP type I, 88.90% of CSP type II and 50% of CSP type III patients were treated with hysteroscopic lesion excision, 7.9% of CSP type I and 2.2% of CSP type II patients underwent ultrasound-monitored curettage, and the remaining patients underwent lesion excision and and simultaneous repair of excised lesions by different routes (trans-laparoscopic, transabdominal or transvaginal methods). And 5.55% of CSP type I, 22.65% of CSP type II and 43.10% of CSP type III patients were treated with adjunctive uterine artery embolization (UAE). The patients were followed up for more than 2 years after surgery. Among the 166 re-pregnancies, 58 (34.94%) were normal pregnancies, 17 patients reoccurred with CSP, the recurrent rate of CSP was 10.24%. All 58 normal pregnancies were terminated by cesarean section, with a mean gestational week of delivery of (38.36 ± 2.25) weeks, a mean birth weight of (3228.45 ± 301.96)g, and the postnatal Apgar score was (9.86 ± 0.23) points at 1 min and all 5 min were 10 points. Logistic regression analysis suggested that the number of previous cesarean deliveries was a risk factor for recurrent CSP (RCSP) (OR = 10.82, 95% CI: 2.52–46.50, P = 0.001). Conclusions The type of CSP is related to β-HCG values, presence of fetal heartbeat, gestational sac diameter and clinical symptoms. Hysteroscopic therapy is a commonly used surgical procedure and UAE is often used as an adjuvant treatment. For subsequent pregnancies, the number of previous cesarean deliveries is a risk factor for recurrent CSP.

show abstract

Section: Discussionsupporting

confidence: 77%

Analysis of pregnancy outcomes following surgical treatment of cesarean scar pregnancy

Sheng

Yang

et al. 2022

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

show abstract

“…The lower level of ß-hCG in type-II ULIP suggests that the development of partially endometrium-encapsulated embryos in these patients might be defective. The below-cutoff EMT group demonstrated higher intraoperative blood loss and longer hospital stay during the procedure of deliberate termination, indicating that the women with type-II ULIP possess enhanced intraoperative and perioperative complexity [25,26]. Therefore, in women with type-II ULIP, the mutually correlated thinner endometrium, peri-GS endometrial interruption, and lower ß-hCG concentration may act synergistically to increase the clinical complexity, which may eventually shift the pregnancy to various unfavorable outcomes, from early pregnancy loss to maternal death, documented in numerous published case reports [2].…”

Section: Discussionmentioning

confidence: 99%

Two subtypes of surgery-categorized upper-lateral intracavitary pregnancy identified by MRI, a retrospective study

Xie

Yang

Shao

et al. 2022

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

Background The pregnancy outcomes in women with surgery-categorized upper-lateral intracavitary pregnancy (ULIP), previously named angular pregnancy, demonstrate higher heterogeneity than in women with ultrasonography-categorized ULIP. We aimed to use preoperative MRI and correlated clinical characteristics to explore whether the surgery-categorized ULIP comprises obstetric conditions undefined by the current ultrasonography-based diagnostic criteria. Methods This retrospective study involved 28 women with surgically and pathologically confirmed ULIP from January 2016 to July 2022. Two board-certified radiologists, blinded to the patients’ information, independently reviewed the MRI images, and determined each MRI feature, including endometrial thickness (EMT) and peri-gestational sac (GS) endometrial interruption. Disagreements were resolved by discussion to achieve a consensus. Based on the cutoff value of EMT (11.5 mm), the patients were divided into above-cutoff EMT (n = 22) and below-cutoff EMT (n = 6) groups. Results Two subtypes of surgery-categorized ULIP were identified. Type-I ULIP (n = 22; EMT ≥ 11.5 mm), when compared to the type-II ULIP (n = 6; EMT < 11.5 mm), demonstrated lower incidence of peri-GS endometrial interruption (2/22 [9.1%] vs 6/6 [100%]; P = 0.001), higher logarithmic ß-human chorionic gonadotropin (ß-hCG) concentration (4.7 ± 0.4 mIU/ml vs 4.2 ± 0.6 mIU/ml; P = 0.026), lower rate of repeated dilatation and curettage (1/22 [4.6%] vs 4/6 [66.7%]; P = 0.003), less intraoperative blood loss (10.1 ± 6.3 ml vs 28.3 ± 18.3 ml; P = 0.001), and shorter hospital stay (2.8 ± 1.7 days vs 7.5 ± 3.8 days; P = 0.001). The peri-GS endometrial interruption negatively correlated with EMT (Odds ratio [OR] = 0.55; P = 0.001) and logarithmic ß-hCG concentration (OR = 0.08; P = 0.045). The below-cutoff EMT negatively correlated with ß-hCG concentration (OR = 0.06; P = 0.021). Conclusions Surgery-categorized ULIP comprised two obstetric conditions among which the type-II ULIP, possessing unique imaging features undocumented in the literature, requires further attention during clinical practice.

show abstract

“…In CSP, the gestation is implanted in a previous cesarean scar ( 14 ), however, it may lead life-threatening results, such as severe hemorrhage and uterine rupture. Although, management options have been described in case reports and small series in the published work ( 13 , 15 , 16 ), there is insufficient evidence to recommend any one specific intervention over another for CSP ( 17 ).…”

Section: Introductionmentioning

confidence: 99%

“…Hysteroscopic niche correction helps improve postmenstrual spotting and restore fertility by treating polyps and the lateral branches of the niche (ectopic endometrium and hyperplastic vessels) and removing their valves (outflow tract or inflow tract to allow the blood to flow smoothly) ( 22 – 24 ). Consequently, in recent years, transvaginal and hysteroscopic procedures have become the two most commonly used treatments of the niche with short operation time, fast postoperative recovery, and effective improvement of niche-related symptoms ( 15 , 20 , 21 , 25 , 26 ).…”

Section: Introductionmentioning

confidence: 99%

Comparative effectiveness of transvaginal repair vs. hysteroscopic resection in patients with symptomatic uterine niche

Xia

Wang²,

Tian³

et al. 2023

Front. Surg.

View full text Add to dashboard Cite

ObjectiveTo compare the efficacy of transvaginal repair and hysteroscopic resection in improving niche associated postmenstrual spotting.MethodsThe improvement rate of postmenstrual spotting in women who underwent transvaginal repair or hysteroscopic resection treatment was assessed retrospectively in patients accepted at the Niche Sub-Specialty Clinic in International Peace Maternity and Child Health Hospital between June 2017 and June 2019. Postoperative spotting symptom within one year after surgery, pre- and postoperative anatomical indicators, women' satisfaction with menstruation and other perioperative parameters were compared between the two groups.Results68 patients in the transvaginal group and 70 patients in the hysteroscopic group were included for analysis. The improvement rate of postmenstrual spotting in the transvaginal group at the 3rd, 6th, 9th, and 12th months after surgery was 87%, 88%, 84%, and 85%, significantly higher than 61%, 68%, 66%, and 68% in the hysteroscopic group, respectively (P < 0.05). The total days of spotting improved significantly at the 3rd month after surgery but did not change over time within one year in each group (P > 0.05). After surgery, the disappearance rates of the niche are 68% in transvaginal group and 38% in hysteroscopic group, however, hysteroscopic resection had shorter operative time and hospitalization duration, less complications, and lower hospitalization costs.ConclusionBoth treatments can improve the spotting symptom and anatomical structures of uterine lower segments with niches. Transvaginal repair is better in thickening the residual myometrium than hysteroscopic resection, however, hysteroscopic resection has shorter operative time and hospitalization duration, less complications, and lower hospitalization costs.

show abstract

Hysteroscopic treatment and reproductive outcomes in cesarean scar pregnancy: experience at a single institution

Cited by 19 publications

References 35 publications

Analysis of pregnancy outcomes following surgical treatment of cesarean scar pregnancy

Analysis of pregnancy outcomes following surgical treatment of cesarean scar pregnancy

Two subtypes of surgery-categorized upper-lateral intracavitary pregnancy identified by MRI, a retrospective study

Comparative effectiveness of transvaginal repair vs. hysteroscopic resection in patients with symptomatic uterine niche

Contact Info

Product

Resources

About