Type 2 Cesarean Scar Pregnancy Successfully Treated via Hysteroscopy-Assisted Laparoscopy

Qi, Feng; Chai, Zeying; Liu, Manman; Zheng, Lingzhi; Zhu, Ying; Chen, Zheng-Wen; Lü, Weiguo

doi:10.1016/j.jmig.2018.11.019

Cited by 17 publications

(13 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Until now, there have been few studies on the treatment of CSP according to its classification. Our previous research shows that hysteroscopy-assisted laparoscopy is safe and effective for type 2 CSP (Qi et al, 2019), which has been confirmed by other similar studies (Wang et al, 2014;Shen et al, 2021). As the gestational sac is implanted on the scar and grows toward the uterine cavity, the risk of type 1 CSP is relatively lower, therefore, we evaluate the treatment of type 1 CSP based on the therapeutic effect and health economics.…”

Section: Discussionsupporting

confidence: 68%

The Efficacy and Health Economics of Different Treatments for Type 1 Cesarean Scar Pregnancy

et al. 2022

Self Cite

View full text Add to dashboard Cite

Objectives: To evaluate the efficacy and health economics of four treatments for type 1 cesarean scar pregnancy (CSP).Methods: From January 2009 to December 2018, 326 patients diagnosed with type 1 CSP were examined, among whom 31 received ultrasound-guided local injection of methotrexate (local injection group), 160 patients received uterine artery embolization combined with suction aspiration (UAE group), 25 patients received ultrasound-guided suction aspiration (aspiration group) and 90 received ultrasound-guided local injection of lauromacrogol combined with suction aspiration (lauromacrogol group). Clinical data and outcomes were analyzed. The decision tree model was used to compare the economics of four treatments.Results: The success rate of the local injection group was 71.0% (22/31), which was significantly different from 98.8% (158/160) of the UAE group and 100.0% (90/90) of the lauromacrogol group. The success rate of the aspiration group was 92.0% (23/25), which was significantly lower than that of the lauromacrogol group. The cost-effectiveness ratio was 1,876.53 yuan for the aspiration group, 2,164.63 yuan for the lauromacrogol group, 4,383.56 yuan for the local injection group, and 7,850.81 yuan for the UAE group. The Incremental cost effectiveness ratio (ICER) of the lauromacrogol group to the aspiration group was 5,477.75 yuan, indicating that if the willing to pay of patients was higher than 5,477.75 yuan, the lauromacrogol group had a cost-effectiveness advantage in treating type 1 CSP, compared to aspiration group. On the contrary, aspiration group has a higher cost-effectiveness advantage. The ICER of the lauromacrogol group to the local injection group or the UAE group were both less than 0, indicating that local injection group and UAE group was not cost-effective in the treatment of type 1 CSP.Conclusion: For type 1 CSP, the ultrasound-guided local injection of lauromacrogol combined with suction aspiration and ultrasound-guided suction aspiration, are effective and economical, and the choice between the two can be based on the patient’s willing to pay.

show abstract

Section: Discussionsupporting

confidence: 68%

The Efficacy and Health Economics of Different Treatments for Type 1 Cesarean Scar Pregnancy

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…A total of 358 articles were identified; 122 were assessed with respect to their eligibility for inclusion and 44 studies were included in the systematic review (Table 1, Figure 1). 9,10,21‐61 These studies included 3598 women with a prior CSP; of these, information on subsequent pregnancy was available for 592 women.…”

Section: Resultsmentioning

confidence: 99%

Reproductive outcome after cesarean scar pregnancy: A systematic review and meta‐analysis

Morlando

Buca

Timor‐Tritsch

et al. 2020

Acta Obstet Gynecol Scand

View full text Add to dashboard Cite

Introduction To evaluate subsequent reproductive among women with a prior cesarean scar pregnancy (CSP). Material and methods MEDLINE, Embase and ClinicalTrials.gov databases were searched. Inclusion criteria were women with a prior CSP, defined as the gestational sac or trophoblast within the dehiscence/niche of the previous cesarean section scar or implanted on top of it. The primary outcome was the recurrence of CSP; secondary outcomes were the chance of achieving a pregnancy after CSP, miscarriage, preterm birth, uterine rupture and the occurrence of placenta accreta spectrum disorders. Subgroup analysis according to the management of CSP (surgical vs non‐surgical) was also performed. Random effect meta‐analyses of proportions were used to analyze the data. Results Forty‐four studies (3598 women with CSP) were included. CSP recurred in 17.6% of women. Miscarriage, preterm birth and placenta accreta spectrum disorders complicated 19.1% (65/341), 10.3% (25/243) and 4.0% of pregnancies, and 67.0% were uncomplicated. When stratifying the analysis according to the type of management, CSP recurred in 21% of women undergoing surgical and in 15.2% of those undergoing non‐surgical management. Placenta accreta spectrum disorders complicated 4.0% and 12.0% of cases, respectively. Conclusions Women with a prior CSP are at high risk of recurrence, miscarriage, preterm birth and placenta accreta spectrum. There is still insufficient evidence to elucidate whether the type of management adopted (surgical vs non‐surgical) can impact reproductive outcome after CSP. Further large, prospective studies sharing an objective protocol of prenatal management and long‐term follow up are needed to establish the optimal management of CSP and to elucidate whether it may affect its risk of recurrence and pregnancy outcome in subsequent gestations.

show abstract

“…Therefore, our case presents a different management method for this type of ectopic pregnancy - the use of Myosure hysteroscopy. The use of hysteroscopy for the treatment of this cesarean scar pregnancy has been cited a few times in the literature thus far [ 11 , 12 ]. The use of Myosure has been cited once for the management of cornual ectopic pregnancy [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Successful Use of Myosure in the Management of Cesarean Scar Ectopic Pregnancy

Daram¹,

Berry²,

Fakih³

et al. 2021

Cureus

View full text Add to dashboard Cite

Cesarean scar pregnancy (CSP) is a very serious complication of a prior cesarean delivery. The major risks associated with CSP are uncontrolled hemorrhage and uterine rupture, potentially leading to future infertility. Management of CSP remains a major obstetric challenge without a well-defined therapeutic procedure. Dilation & curettage is a commonly used procedure for the treatment of CSP. However, it can be ineffective and often leads to definite infertility. Therefore, we present a case of the successful use of an alternative procedure, Myosure® hysteroscopy, in the treatment of CSP. We herein report the case of a 32year-old G5P3013 woman who presented with vaginal bleeding and past history of three cesarean sections. She was found to have a CSP with fetal pole and cardiac activity at 6 weeks 2 days. The patient was initially treated with a systemic methotrexate injection, but there was persistence of cardiac activity. A second course of methotrexate was administered into the gestational sac, which systemically led to successful fetal cardiac arrest and downtrend of beta-human chorionic gonadotropin (HCG) level. A dilation & curettage procedure was not successful in removing products of conception. A Myosure hysteroscopy procedure, however, was successful in removing products of conception. The patient was discharged after a negative ultrasound and beta-HCG level. In our review of the literature, we found that there is no general consensus on the management of cesarean scar ectopic pregnancies. To date, there is no literature cited about the use of Myosure for cesarean scar ectopic pregnancies. However, our case suggests that Myosure can be effective for CSP and this warrants a larger-scale controlled study to better evaluate this as a treatment for this condition.

show abstract

Type 2 Cesarean Scar Pregnancy Successfully Treated via Hysteroscopy-Assisted Laparoscopy

Cited by 17 publications

References 57 publications

The Efficacy and Health Economics of Different Treatments for Type 1 Cesarean Scar Pregnancy

The Efficacy and Health Economics of Different Treatments for Type 1 Cesarean Scar Pregnancy

Reproductive outcome after cesarean scar pregnancy: A systematic review and meta‐analysis

Successful Use of Myosure in the Management of Cesarean Scar Ectopic Pregnancy

Contact Info

Product

Resources

About