Management of cesarean scar pregnancy with suction curettage: a report of four cases and review of the literature

Tekın, Yeşim Bayoğlu; Ural, Ülkü Mete; Balık, Gülşah; Üstüner, İşık; Şahin, Figen Kır; Güven, Emine Seda Güvendağ

doi:10.1007/s00404-014-3143-6

Cited by 33 publications

(27 citation statements)

References 16 publications

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“…However, despite the rising incidence of CSP, there is still no consensus as to the best treatment modality for this condition. Although preservation of fertility is generally considered an important factor in determining the appropriate treatment option for clinically stable cases, surgical intervention is recommended by some authors with theoretical advantages of having quicker resolution of the CSP, obtaining tissue for diagnosis confirmation, avoiding the unpredictable response of medical treatment, and facilitating closure and healing of the uterine defect, thus reducing the chance of recurrence [20][21][22][23][24]. In our unit, medical treatment has always been the preferred treatment for CSP because most women want to retain their future fertility, and treatment should be aimed at eliminating the CSP while retaining the woman's fertility.…”

Section: Cheung Ultrasound-guided Local Methotrexate Injection In Cspmentioning

confidence: 99%

Local Methotrexate Injection as the First-line Treatment for Cesarean Scar Pregnancy: Review of the Literature

Cheung¹

2015

Journal of Minimally Invasive Gynecology

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Section: Cheung Ultrasound-guided Local Methotrexate Injection In Cspmentioning

confidence: 99%

Local Methotrexate Injection as the First-line Treatment for Cesarean Scar Pregnancy: Review of the Literature

Cheung¹

2015

Journal of Minimally Invasive Gynecology

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“…As less-invasive management options, a variety of medications (methotrexate (MTX), etoposide, and potassium chloride) have been adopted in the treatment of CSP [2, 4, 6]. Surgical managements include dilation and curettage (D&C) [7–9], uterine artery embolisation (UAE) [10] coupled with MTX arterial injection [11], hysteroscopy [12–15], and laparoscopy [16]. Hysterectomy is usually performed in emergencies such as heavy bleeding or uterine rupture.…”

Section: Introductionmentioning

confidence: 99%

Management of persistent caesarean scar pregnancy after curettage treatment failure

Qian

Weng

et al. 2017

BMC Pregnancy Childbirth

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BackgroundCaesarean scar pregnancy (CSP) is a late serious complication of caesarean section. The incidence of CSP has increased worldwide in recent years. Early diagnosis and prompt therapy are crucial to avoid catastrophic complications. There are various strategies for CSP treatment, but there is no consensus on the best management for CSP. Dilation and curettage (D&C) and hysteroscopy are common and effective treatments with their advantages and disadvantages. No in-depth study of the clinical effects of hysteroscopic management of CSP after D&C treatment failure has been conducted. The purpose of this study is to evaluate the effectiveness and safety of hysteroscopic removal of residual CSP tissue (persistent CSP) as a rescue after failed D&C management.MethodsThis is a retrospective clinical research study. Forty-five patients underwent operative hysteroscopy to remove the residual gestational tissue in the caesarean scar after failed D&C treatment. The clinical characteristics and outcomes of hysteroscopic surgeries of 45 CSP cases were investigated. All data analyses were conducted with SPSS 17.0.ResultsForty-three CSP cases after unsuccessful curettage treatment were successfully treated by operative hysteroscopy. The estimated intraoperative blood loss was 20.00 (10.00–500.00) mL, the hysteroscopic operating time was 20.00 (15.00–45.00) min, the decline of serum β-hCG the day after surgery was 71.91 ± 14.05%, the total hospitalisation time was 7.87 ± 2.26 days, the medical cost was 13,682.71 ± 3553.77 China Yuan (CNY), the time of bleeding after surgery was 7.42 ± 2.48 days, and the time of serum β-hCG resolution after surgery was 13.84 ± 9.83 days. Follow-up after discharge demonstrated that there were no severe complications for any patients.ConclusionsHysteroscopy therapy could treat persistent CSP effectively and safely after curettage treatment failure. Therapy should be individualised, and the risks and cost of the hysteroscopy procedure and anaesthesia must be considered and fully discussed with the patients before surgery.

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“…Patients - with full bladders - were placed on an operating table in the lithotomy position, and a convex abdominal probe was inserted into the suprapubic region to visualize the uterus. After inserting the speculum into the vagina, the cervix was swabbed with gauze, and the anterior lip was grasped with a toothed tenaculum [12]. The cervix was widened with Hegar dilators until it reached a diameter of 10 mm to facilitate a possible tamponade with iodoform gauze packs, then a No.…”

Section: Methodsmentioning

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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Management of cesarean scar pregnancy with suction curettage: a report of four cases and review of the literature

Abstract: Suction curettage is a viable alternative for conservative treatment in selected cases of patients who are diagnosed with CSP early in gestation and who have a myometrial thickness of more than 4.5 mm.

Cited by 33 publications

References 16 publications

Local Methotrexate Injection as the First-line Treatment for Cesarean Scar Pregnancy: Review of the Literature

Local Methotrexate Injection as the First-line Treatment for Cesarean Scar Pregnancy: Review of the Literature

Management of persistent caesarean scar pregnancy after curettage treatment failure

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

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