Intrauterine ectopic pregnancy — ultrasound typing and treatment

Abstract

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.

Comparing the clinical efficacy of three surgical methods for cesarean scar pregnancy

“…Ultrasound can effectively diagnose CSP early in the pregnancy. Ultrasound examination can determine the status of pregnancy tissues in patients and is instrumental in assisting CSP typing [ 9 ].…”

Analysis of pregnancy outcomes following surgical treatment of cesarean scar pregnancy

“…High levels of blood β-HCG do not imply a reduced success rate of conservative treatment [ 16 ]. In the present study, patients with CSP type II and III had higher blood β-HCG levels and sac diameter than patients with CSP type I, which may be due to the fact that blood β-HCG levels and gestational sac size suggest different periods of pregnancy, reflecting a more abundant blood flow around the gestational sac, and correlate to some extent with the severity of CSP [ 17 ]. However, both types II and III of CSP group in our study were combined with significantly reduced ratio of fetal heart beats, it might be due to that scarred site of gestational sac implantation was unsuitable for embryonic development.…”

Elective embryo or fetal reduction for caesarean scar pregnancy combined with intrauterine pregnancy

“…Treatment options for CSP should be based on the patient's condition and the surgeon's skill [3,17]. These treatments include surgical removal, hysteroscopic resection, and suction curettage [4][5][6][7][18][19][20][21]. Among them, a local KCl injection has been reportedly used to successfully treat CSP [20,22].…”

“…Severe bleeding may occur during early pregnancy owing to the lack of endometrium and myometrium. Most reported CSP cases are single (embryo) CSP [3][4][5][6][7]. Multiple CSP cases are rarer and generally are a result of assisted reproduction [8,9].…”