Is hysteroscopic treatment of cesarean scar pregnancy the best option?

Miller, Charles E.; McKenna, Mary M.

doi:10.1016/j.fertnstert.2021.09.034

Cited by 2 publications

(2 citation statements)

References 4 publications

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“…Excision of the CSP and subsequent repair of the scar may constitute a more favorable management approach, offering potential benefits for future fertility. 19 These challenges were also encountered within our institution, where the multitude of available treatment options posed difficulty for physicians in selecting the most appropriate course of action. Previous research has indicated that certain high-risk factors, such as a gestational sac exceeding 4.5 cm or a myometrial thickness less than 2 mm, can contribute to the persistence of CSP following initial surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

Clinical Application of a New Cesarean Scar Pregnancy Classification and Evaluation System and a Risk Scoring System

Fu,

Zhang,

Zhou

et al. 2024

IJGM

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Cesarean scar pregnancy (CSP) is an uncommon form of ectopic pregnancy that carries the risk of severe bleeding. To date, there has not been a universally accepted classification and treatment strategy. We performed this study to establish a risk scoring system and new CSP classification system for CSP and evaluate its efficacy. Methods: A total of five groups were generated based on different methods of treatment, and the factors that increase the risk of intraoperative bleeding were examined in our center from 2013 to 2018. The construction of a risk scoring system in this study was based on the use of the chi-square test and multivariate logistic regression analysis. To determine the appropriate cutoff scores, receiver operating characteristic (ROC) curves and the area under the curve (AUC) were generated. Results: We identified the main high-risk factors for excessive intraoperative hemorrhage during CSP surgery through univariate and multivariate analyses. Within this investigation, the risk factors included gestational sac location and gestational sac diameter. Through analysis, an optimal cutoff score of 3 was determined, and the area under the ROC curve was calculated to be 0.8113 (95% CI=0.7696-0.8531). A score ranging from 0-3 was classified as low risk, while a score ranging from 5-7 was classified as high risk. Additionally, a new classification system for CSP has been established based on sonographic parameters. We also established a diagnostic and treatment process for CSP patients according to the risk scoring method and new CSP classification. Conclusion:We identified the high-risk factors associated with bleeding during CSP surgery and developed a scoring system incorporating these factors. The utilization of this novel CSP typing method, in conjunction with the risk scoring system, can effectively inform doctors in their decision-making process concerning treatment strategies for patients with CSP.

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Section: Discussionmentioning

confidence: 99%

Clinical Application of a New Cesarean Scar Pregnancy Classification and Evaluation System and a Risk Scoring System

Fu,

Zhang,

Zhou

et al. 2024

IJGM

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“…These treatment modalities include expectant management, medical treatment by systemic methotrexate (MTX), medical treatment by systemic and local MTX, treatment by needle aspiration and local MTX, uterine curettage, hysteroscopy, resection of CSP through a transvaginal approach, uterine artery embolization (UAE), laparoscopy, and high-intensity focused ultrasound. [8][9][10][11][12][13] Various types of agents, such as potassium chloride (KCl), MTX, and vasopressin, have been experimented with for intragestational injection. [14][15][16] CSP can be a life-threatening condition if unrecognized and inadequately managed.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Treatment of Cesarean Scar Ectopic Pregnancies with Alcohol Injection to the Gestational Sac and Dilatation Curettage with or without Systemic Methotrexate: A Case-Control Study

Şen Selim,

Yurtçu,

Atalay

et al. 2024

anajog

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Purpose:We aim to assess the effectiveness of treating cesarean scar ectopic pregnancies by injecting alcohol into the gestational sac (GS) and performing dilatation curettage with or without prior systemic methotrexate (MTX) administration.Methods: A total of 37 patients were treated for cesarean scar pregnancy (CSP), 11 of which received systemic 75 mg MTX three days before local injection of 10% alcohol into the GS via 18G double lumen oocyte pick-up needle (Geotek, Ankara, Turkey) and 26 cases received local alcohol injection without prior MTX. Two or three days after the alcohol injection, the products of conception were removed again with a Karman cannula, and the β-hCG level was monitored weekly. After termination of CSP , the patients were followed up until they used contraception or delivered the following pregnancy. Results:The MTX plus alcohol injection group and the alcohol injection alone group were compared. Significantly more women required Foley balloon tamponade 13 (50%), erythrocyte transfusion 13 (50%), and fresh frozen plasma infusion 9 (34.6%) in the local alcoholl injection alone group compared to the MTX plus alcohol group [n=1 (9.1%) p=0.01, n=1 (9.1%) p=0.01, n=0 p=0.02, respectively]. The mean resolution time of β-hCG was shorter in the MTX group [m=25±7.1 (18-48) and m=32.6±9.3 (22-58), p=0.01]; also; however, long hospitalization time was a disadvantage in this group. The recurrent CSP rate of 7.7% (n=2) was higher in the local alcohol injection alone group compared to nil in the MTX group. Cesarean niche surgery, abortion rate, and term pregnancy rates were similar in the two groups. Conclusion:Although the efficacy of local alcohol injection alone is comparable to MTX plus alcohol injection, this group is at a disadvantage due to increased hemorrhage risk and the need for hemorrhage management. Local alcohol injection in combination with systemic MTX may be utilized as a good treatment option in patients.

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Is hysteroscopic treatment of cesarean scar pregnancy the best option?

Cited by 2 publications

References 4 publications

Clinical Application of a New Cesarean Scar Pregnancy Classification and Evaluation System and a Risk Scoring System

Clinical Application of a New Cesarean Scar Pregnancy Classification and Evaluation System and a Risk Scoring System

Efficacy of Treatment of Cesarean Scar Ectopic Pregnancies with Alcohol Injection to the Gestational Sac and Dilatation Curettage with or without Systemic Methotrexate: A Case-Control Study

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