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Cao G, Liu R, Liu J, Liu J, Liu Y, Li L, Zhao X, Li H, Cao H. Association of menstrual blood volume and reproductive outcomes in patients with caesarean scar pregnancy managed using uterine artery embolization and curettage. HUM FERTIL 2023; 26:1491-1496. [PMID: 37154620 DOI: 10.1080/14647273.2023.2207746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 04/11/2023] [Indexed: 05/10/2023]
Abstract
This study aimed to assess the association of menstrual blood volumes (MBV) and reproductive outcomes in patients after uterine artery embolization (UAE) combined with curettage for caesarean scar pregnancy (CSP). This retrospective observational study enrolled women who underwent UAE plus curettage for CSP at the Interventional Department of Henan Provincial People's Hospital between December 2012 and December 2017. The primary outcome was pregnancy rate and the secondary outcomes were live birth rate (LBR) and interpregnancy interval. This study finally included 37 women (16 women with normal MBV and 21 women with decreased MBV) with pregnancy intention after UAE plus curettage for CSP. The pregnancy rate in women with normal MBV was higher than those with decreased MBV (81.3% vs. 47.6%; P = 0.048). There were no differences between the two groups regarding the interpregnancy interval (18.4 ± 8.7 vs. 22.2 ± 10.0 months, P = 0.233), and LBR (63% vs. 38%, P = 0.191). In conclusion, Women with normal MBV after UAE combined with curettage for CSP management might have a higher pregnancy rate compared with patients with decreased MBV, but there were no differences in LBR between the two groups.
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Affiliation(s)
- Guangshao Cao
- Department of Intervention, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou City, P.R. China
| | - Ruiqing Liu
- Department of Intervention, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou City, P.R. China
| | - Jianwen Liu
- Department of Intervention, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou City, P.R. China
| | - Jian Liu
- Department of Intervention, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou City, P.R. China
| | - Yuyan Liu
- Department of Intervention, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou City, P.R. China
| | - Lupeng Li
- Department of Intervention, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou City, P.R. China
| | - Xiaoyang Zhao
- Department of Intervention, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou City, P.R. China
| | - Hui Li
- Department of Gynaecology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou City, P.R. China
| | - Huicun Cao
- Department of Intervention, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou City, P.R. China
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Lu L, Shao Y, Qu Z, Huang G, Lang S, Yang C, Lang S, Fang S. Outcomes of prophylactic lauromacrogol injection versus non-injection in patients with endogenous cesarean scar pregnancy treated by hysteroscopic surgery: a retrospective cohort study. BMC Pregnancy Childbirth 2023; 23:771. [PMID: 37925452 PMCID: PMC10625229 DOI: 10.1186/s12884-023-06088-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 10/26/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND This study aimed to investigate the efficacy of hysteroscopic surgery for endogenous cesarean scar pregnancy (CSP) and the value of prophylactic ultrasound-guided local injection of lauromacrogol. METHODS This retrospective study included 131 patients diagnosed with endogenous CSP who underwent hysteroscopic surgery at the Hangzhou Fuyang Women and Children Hospital between January 2018 and May 2022. Lauromacrogol (10-20 mL) was administered within 24 h preoperatively using an ultrasound-guided vaginal injection to 78 patients (L group) versus not administered to 53 patients (non-L group). Their clinical data and outcomes were analyzed. RESULTS Mean gestational age, gestational mass size, and uterine scar thickness and median preoperative blood β-human chorionic gonadotropin levels of the non-L versus L groups were 46.26 versus 45.01 days, 2.05 versus 2.39 cm, 0.35 versus 0.32 cm, and 19850.0 versus 26790.0 U/L, respectively (P > 0.05 for each). The non-L and L groups had similar success rates (98.1% vs. 98.7%, P = 1.0). Complications related to lauromacrogol administration, including abdominal pain, massive bleeding, and bradycardia, were experienced by 46.2% (36/78; P < 0.001) of L group patients. The non-L had a significantly shorter mean hospital stay (4.85 ± 1.12 vs 5.44 ± 1.08 days) and lower total cost (6148.75 ± 1028.71 vs 9016.61 ± 1181.19) (P < 0.01). CONCLUSIONS Hysteroscopic surgery is effective and safe for patients with endogenous CSP. Prophylactic lauromacrogol injection increases the incidence of complications and costs. Direct hysteroscopic surgery can reduce pain and financial burden in patients with endogenous CSP and save medical resources for other patients.
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Affiliation(s)
- Lei Lu
- Department of Gynecology, Hangzhou Fuyang Women and Children Hospital, Hangzhou, China.
| | - Yiming Shao
- Department of Gynecology, Hangzhou Fuyang Women and Children Hospital, Hangzhou, China
| | - Zhaoyang Qu
- Department of Gynecology, Hangzhou Fuyang Women and Children Hospital, Hangzhou, China
| | - Guilian Huang
- Department of Gynecology, Hangzhou Fuyang Women and Children Hospital, Hangzhou, China
| | - Suping Lang
- Department of Gynecology, Hangzhou Fuyang Women and Children Hospital, Hangzhou, China
| | - Caiqun Yang
- Department of Ultrasonography, Hangzhou Fuyang Women and Children Hospital, Hangzhou, China
| | - Siqi Lang
- Medical Record Room, Hangzhou Fuyang Women and Children Hospital, Hangzhou, China
| | - Shuying Fang
- Department of Gynecology, Hangzhou Fuyang Women and Children Hospital, Hangzhou, China
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Lin R, DiCenzo N, Rosen T. Cesarean scar ectopic pregnancy: nuances in diagnosis and treatment. Fertil Steril 2023; 120:563-572. [PMID: 37506758 DOI: 10.1016/j.fertnstert.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 07/30/2023]
Abstract
A cesarean scar ectopic pregnancy (CSEP) occurs when the embryo implants on the scar of a previous cesarean delivery. The number of births delivered by cesarean section has climbed by 50% over the last decade, from a nadir of 20.7% in 1996 to 32.1% in 2021. As a result, the incidence of CSEP has also increased. Because CSEP may cause serious morbidity such as life-threatening hemorrhage, uterine rupture, placental accreta spectrum, hysterectomy, and even mortality, accurate diagnosis and appropriate management of this condition are essential. This review focuses on the etiology, incidence, clinical diagnosis, and management of CSEPs.
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Affiliation(s)
- Ruby Lin
- Department of Obstetrics and Gynecology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
| | - Natalie DiCenzo
- Department of Obstetrics and Gynecology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Todd Rosen
- Department of Obstetrics and Gynecology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Baffero GM, Busnelli A, Ronchi A, Somigliana E, Bulfoni A, Ossola MW, Simone ND, Ferrazzi EM. Different management strategies for cesarean scar pregnancy: Short-term outcomes and reproductive prognosis. J Gynecol Obstet Hum Reprod 2023; 52:102607. [PMID: 37210011 DOI: 10.1016/j.jogoh.2023.102607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 05/17/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE To investigate the impact on future reproductive potential of systemic methotrexate (MTX) administration, uterine artery embolization (UAE) and expectant management as treatments of caesarean scar pregnancy (CSP) and to assess their efficacy and safety. BASIC PROCEDURES We retrospectively analysed patients with a diagnosis of CSP treated in a five years' period (2014-2018). Hospitalization, hCG normalization, menstrual cycle recovery, ultrasound restitutio ad integrum times, reproductive desire accomplishment after the resolution of the picture, and outcomes of subsequent pregnancies were considered. Only patients for whom complete diagnosis, treatment and follow-up data were available could be considered for study entry. MAIN FINDINGS A total of 21 patients were included. Three of them were managed expectantly. In two cases spontaneous abortion occurred and one case underwent caesarean delivery at 35 weeks of gestation for complete placenta previa with hysterectomy for post partum haemorrhage. Seven patients were treated with systemic MTX. Median [IQR] times of hospitalization, hCG normalization, menstrual cycle recovery and ultrasound restitutio ad integrum were 21 days [10-26 days], 52 days [18-64 days], 8 weeks [6-10 weeks] and 8 weeks [6-11 weeks] respectively. At the end of follow up, 80% (95%CI [38-96%]) of patients with reproductive desire achieved at least one live birth. Eleven patients were treated with UAE combined with MTX. Median [IQR] times of hospitalization, hCG normalization, menstrual cycle recovery and ultrasound restitutio ad integrum were 14 days [12-20 days], 43 days [30-52 days], 8 weeks [4-12 weeks] and 8 weeks [8-10 weeks], respectively. Of those who expressed a reproductive desire after treatment, 80% (95%CI [49-94%]) achieved at least one live birth. In all included patients, the menstrual cycle was restored. PRINCIPAL CONCLUSIONS Reproductive potential of women treated for CSP was preserved after both systemic MTX administration and systemic MTX combined with UAE. Both strategies proved to be safe.
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Affiliation(s)
- Giulia M Baffero
- Obstetrics and Gynaecology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via M Fanti 6, 20122 Milan, Italy
| | - Andrea Busnelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy.
| | - Alice Ronchi
- Obstetrics and Gynaecology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via M Fanti 6, 20122 Milan, Italy
| | - Edgardo Somigliana
- Obstetrics and Gynaecology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via M Fanti 6, 20122 Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Alessandro Bulfoni
- Division of Obstetrics and Gynecology, Humanitas S. Pio X Hospital, Milan, Italy
| | - Manuela W Ossola
- Obstetrics and Gynaecology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via M Fanti 6, 20122 Milan, Italy
| | - Nicoletta Di Simone
- Obstetrics and Gynaecology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via M Fanti 6, 20122 Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Enrico M Ferrazzi
- Obstetrics and Gynaecology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via M Fanti 6, 20122 Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Liu Y, Wang L, Zhu X. Efficacy and Safety of High-intensity Focused Ultrasound Compared with Uterine Artery Embolization in Cesarean Section Pregnancy: A Meta-analysis. J Minim Invasive Gynecol 2023; 30:446-454. [PMID: 36893898 DOI: 10.1016/j.jmig.2023.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE To investigate the efficacy and safety of high-intensity focused ultrasound (HIFU) compared with uterine artery embolization (UAE) in cesarean section pregnancy (CSP) and to calculate the success rate of HIFU. DATA SOURCES We searched PubMed, Cochrane, Scopus, Web of Science, and Embase on September 30, 2022, and the related studies were independently reviewed by 2 researchers. METHODS OF STUDY SELECTION Medical subject headings and relevant terms from other articles were used for the database search. Patients with CSP who underwent HIFU were included in this analysis. The following results were recorded: success rate, intraoperative blood loss, time for serum beta-human chorionic gonadotropin (beta-HCG) normalization and menstruation recovery, adverse events, hospitalization time, and hospitalization expenses. We used the Newcastle-Ottawa Scale scoring system and the methodological index for nonrandomized studies system to evaluate the quality of the studies. TABULATION, INTEGRATION, AND RESULTS Data from 6 studies were used to compare the efficacy and safety of UAE and HIFU. We pooled the success rate of HIFU by including 10 studies. No data overlap between the 10 studies. Success rate was higher in the HIFU group (odds ratio [OR] = 1.90; 95% confidence interval [CI] 1.06-3.41; p = .03; I2 = 0). We performed the meta-analysis of single rate in R 4.2.0 software, and the success rate of HIFU group was 0.94 (95% CI 0.92-0.96; p = .04; I2 = 48%). Intraoperative blood loss (mean difference [MD]= -21.94 mL; 95% CI -67.34 to 23.47; p = .34; I2 = 99%) and time for serum beta-HCG normalization (MD = 3.13 days; 95% CI 0.02-6.25; p = .05; I2 = 70%) were not significantly different. Time to menstruation recovery (MD = 2.72 days; 95% CI 1.32-4.12; p = .0001; I2 = 0) in the UAE group was shorter than that in the HIFU group. Adverse events were not significantly different between the 2 groups (OR = 0.53; 95% CI 0.22-1.29; p = .16; I2 = 81%). Hospitalization time was not significantly different between the HIFU and UAE groups (MD = -0.41 days; 95% CI -1.14 to 0.31; p = .26; I2 = 55%). Hospitalization expenses of the HIFU group were lower than those of the UAE group (MD = -7488.49 yuan; 95% CI -8460.13 to -6516.84; p <.000; I2 = 0). Heterogeneity of the time for beta-HCG normalization, adverse events, and hospitalization time were improved after excluding one study, and HIFU showed better results in the sensitivity analysis of adverse events and hospitalization time. CONCLUSION According to our analysis, HIFU demonstrated satisfactory treatment success, accompanied by similar intraoperative blood loss, slower normalization of beta-HCG levels, and menstruation recovery, but potentially shorter hospitalization time, lower adverse events and lower costs than UAE. Therefore, HIFU is an effective, safe, and economical treatment for patients with CSP. These conclusions should be interpreted with caution because of the significant heterogeneity. However, large and strictly designed clinical trials are required to verify these conclusions.
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Affiliation(s)
- Yu Liu
- From the Obstetrics and Gynecology of the Hainan Hospital of PLA General Hospital (Drs. Liu, and Zhu), Sanya, Hainan Province, China
| | - Lumin Wang
- Longquanyi District of Chengdu Maternity and Child Healthcare Hospital (Dr. Wang), Longquanyi District, Chengdu, Sichuan Province, China
| | - Xiaoming Zhu
- From the Obstetrics and Gynecology of the Hainan Hospital of PLA General Hospital (Drs. Liu, and Zhu), Sanya, Hainan Province, China.
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Comparison of clinical safety and efficacy of ultrasound-guided local lauromacrogol injection versus uterine artery embolization in the treatment of caesarean scar pregnancy: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2023; 23:149. [PMID: 36882695 PMCID: PMC9990192 DOI: 10.1186/s12884-023-05455-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/19/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND The aim of this systematic review and meta-analysis was to introduce the relatively novel method of ultrasound-guided local lauromacrogol injection (USG-LLI) followed by dilatation and curettage for caesarean scar pregnancy (CSP) and to investigate the clinical safety and efficacy between uterine artery embolization (UAE) and USG-LLI in the treatment of CSP. METHODS The relevant literature and articles about USG-LLI, UAE and CSP published in eight electronic databases were searched to extract the primary outcomes for the selected articles. Review Manager Software(RevMan) V.5.2 was used for quantitative data synthesis and data analysis. Forest plots, sensitivity analysis and bias analysis were also performed on the included articles. RESULTS Of 10 studies included in our search, 623 patients were in the USG-LLI group and 627 patients were in the UAE groups. There were no significant differences between the two groups in terms of success rate, blood loss and time to human chorionic gonadotropin (hCG) normalization. However, USG-LLI group patients than UAE group patients had a shorter duration of hospital stay (mean difference [MD] = -1.97; 95% confidence intervals [CI] -2.63 to -1.31; P < 0.05; I2 = 95%), shorter restored menses (MD = -4.84; 95%CI -5.78 to -3.90; P < 0.05; I2 = 95%), and lower complication rates [odds ratio(OR) = 0.21; 95%CI:0.15 to 0.30; P < 0.05]; and cheaper on expenses of hospitalization (MD = -8028.29; 95%CI -10,311.18 to -5745.40; P < 0.05; I2 = 100%). CONCLUSIONS The results demonstrate that USG-LLI is comparable in curative effect and success rates with UAE in the therapy of CSP, but patients in the USG-LLI group seem to have fewer complications rates, shorter duration of hospital stays and lower costs.
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Marchand GJ, Masoud AT, Coriell C, Ulibarri H, Parise J, Arroyo A, Goetz S, Moir C, Moberly A, Govindan M. Treatment of Cesarean Scar Ectopic Pregnancy in China with Uterine Artery Embolization-A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11247393. [PMID: 36556010 PMCID: PMC9783593 DOI: 10.3390/jcm11247393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/28/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022] Open
Abstract
Cesarean scar ectopic pregnancy (CSP) is a rare form of ectopic pregnancy, and treatment of CSP with uterine artery embolization (UAE) is a novel approach. With increasing numbers of cesarean sections being performed annually, the incidence of this condition is likely to increase. The authors became aware of an unusually high number of published studies originating in mainland China regarding this unusual treatment and sought to perform a meta-analysis to provide comprehensive evidence on this novel practice. METHODS We performed a thorough search and included all forms of quality studies on this topic that reported UAE as a part of first-line management of CSP. We included only studies originating in China. Ultimately, 37 studies were included for qualitative and quantitative synthesis of evidence. After screening retrieved records and extracting data from eligible studies, we pooled continuous data as a mean estimate and 95% confidence interval (CI), and dichotomous data as proportion and 95% CI. RESULTS CSP patients treated with protocols including UAE had a mean time of 30 days for serum β-hCG normalization, 95% CI [26.816, 33.881]. They had a mean estimated intraprocedural blood loss of 4.19 ± 3.76 mL, a mean hospital stay of nine days, 95%CI [7.914, 9.876], and a success rate of 93.4%, 95%CI [0.918, 0.951]. The severe complication rate was 1.2%, 95%CI [0.008, 0.017]. CONCLUSION UAE, in combination with other procedures is being used effectively for the treatment of CSP in China. Protocols including UAE have a success rate of approximately 93.4%, and a severe complication rate of approximately 1.2%. This data's utility is limited by vast differences in the studied protocols and questionable feasibility outside of China.
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Affiliation(s)
- Greg J. Marchand
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ 85209, USA
- Correspondence:
| | - Ahmed Taher Masoud
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ 85209, USA
- Faculty of Medicine, Fayoum University, Fayoum 63514, Egypt
| | - Catherine Coriell
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ 85209, USA
| | - Hollie Ulibarri
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ 85209, USA
| | - Julia Parise
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ 85209, USA
| | - Amanda Arroyo
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ 85209, USA
| | - Sydnee Goetz
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ 85209, USA
| | - Carmen Moir
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ 85209, USA
| | - Atley Moberly
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ 85209, USA
| | - Malini Govindan
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ 85209, USA
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Liu Y, Yin Q, Xu F, Luo S. Clinical efficacy and safety of high-intensity focused ultrasound (HIFU) ablation in treatment of cesarean scar pregnancy (CSP) I and II. BMC Pregnancy Childbirth 2022; 22:607. [PMID: 35907811 PMCID: PMC9338633 DOI: 10.1186/s12884-022-04848-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 05/26/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate the safety and feasibility of high intensity focused ultrasound (HIFU) ablation followed by ultrasound-guided dilation and curettage (USg-D&C) for two types patients with cesarean scar pregnancy (CSP-I and CSP-II). Materials and methods This study was a retrospective analysis of 101 CSP-I patients and 52 CSP-II patients who received HIFU ablation followed by USg-D&C from Jun 2014 to Oct 2020. The diameter of gestational sac/mass, thickness of the intervening myometrium, intraoperative blood loss, operation time, length of hospital stays, adverse effects and β-HCG level in the two groups were compared. Results All patients successfully received HIFU ablation under conscious sedation. The median total treatment time of HIFU ablation and median USg-D&C time in the CSP-I group were statistically longer than those in the CSP-II group (P < 0.05). The average intraoperative median blood loss was 39 ml in the CSP-I group and 65 ml in the CSP-II group (P < 0.05). The duration of hospitalization was 7.07 ± 1.83 days in the CSP-I group and 7.18 ± 1.72 days in the CSP-II group (P > 0.05). The average time needed for β-HCG return to normal levels was 26.08 ± 5.02. and 28.15 ± 4.99 days for CSP-I and CSP-II, respectively (P > 0.05). The percentage of adverse effects and complications was not significantly different between the two groups (P > 0.05). Conclusions HIFU ablation followed by USg-D&C was safe and effective in treating the CSP-I patients and CSP-II patients, which may be a potential noninvasive therapeutic option for patients with CSP.
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Affiliation(s)
- Yanglu Liu
- School of Medical and Life Sciences,Chengdu University of Traditional Chinese Medicine, 37 Twelfth Bridge Road, Chengdu, 610072, Sichuan, China
| | - Qiaozhi Yin
- School of Medical and Life Sciences,Chengdu University of Traditional Chinese Medicine, 37 Twelfth Bridge Road, Chengdu, 610072, Sichuan, China.,Chengdu Hospital for Reproduction, Women and Children, Chengdu University of Chinese Medicine, Sichuan, Chengdu, China
| | - Fan Xu
- Department of Obstetrics and Gynecology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Shuang Luo
- Department of Obstetrics and Gynecology, Suining Central Hospital, Suinig, Sichuan, People's Republic of China.
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9
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Shao M, Tang F, Ji L, Hu M, Zhang K, Pan J. The management of caesarean scar pregnancy with or without a combination of methods prior to hysteroscopy: ovarian reserve trends and patient outcomes. J Gynecol Obstet Hum Reprod 2022; 51:102417. [PMID: 35667588 DOI: 10.1016/j.jogoh.2022.102417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 05/15/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE This study compared the efficacy and safety of a combination of uterine artery embolization or methotrexate before hysteroscopy in the treatment of cesarean scar pregnancy. METHODS We divided 276 cesarean scar pregnancy patients into three groups. Group A underwent direct hysteroscopy; Group B received uterine artery embolization plus hysteroscopy; Group C received the systemic administration of methotrexate prior to hysteroscopy. RESULTS The patients in Group A lost significantly more blood than those in Groups B (P < 0.05). There were no significant differences between the three groups with regards to massive hemorrhage and transfusion (P > 0.05). None of the patients required hysterectomy. Group A was also associated with a significantly shorter period of hospitalization, reduced medical costs, and fewer adverse events than either Group B or C (P < 0.05). Moreover, among women of advanced age (≥35y), the levels of serum anti-Mullerian hormone in Group B were significantly lower than those of the baseline group (P<0.05), which were significantly lower than those in Group A after surgery (4.22 ± 2.35 vs 2.78± 1.89 ng/ml, P < 0.05). CONCLUSION Direct hysteroscopy is a reliable treatment option for most early type I cesarean scar pregnancy patients with a gestational sac. A combination of methotrexate and uterine artery embolization before hysteroscopy in these patients has limited remedial effects. uterine artery embolization may reduce ovarian reserve in patients aged ≥35y.
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Affiliation(s)
- Mingjun Shao
- Department of Obstetrics and Gynecology, Jinhua Municipal Central Hospital, Jinhua, China
| | - Fei Tang
- Department of Obstetrics and Gynecology, Jinhua Municipal Central Hospital, Jinhua, China
| | - Limei Ji
- Department of Obstetrics and Gynecology, Jinhua Municipal Central Hospital, Jinhua, China
| | - Min Hu
- Department of Obstetrics and Gynecology, Jinhua Municipal Central Hospital, Jinhua, China
| | - Keke Zhang
- Department of Obstetrics and Gynecology, Jinhua Municipal Central Hospital, Jinhua, China
| | - Jiangfeng Pan
- Department of Obstetrics and Gynecology, Jinhua Municipal Central Hospital, Jinhua, China.
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10
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Cao L, Qian Z, Huang L. Comparison of D&C and hysteroscopy after UAE in the treatment of cesarean scar pregnancy: A case-control study. Medicine (Baltimore) 2022; 101:e28607. [PMID: 35060530 PMCID: PMC8772649 DOI: 10.1097/md.0000000000028607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 12/27/2021] [Indexed: 01/05/2023] Open
Abstract
Cesarean scar pregnancy (CSP) stands for the severe complication secondary to cesarean section, and its incidence shows an increasing trend recently. However, no consensus has been reached about the CSP treatment. This study aims to explore the necessity of hysteroscopy (H/S) after preventive uterine artery embolization (UAE).A case-control report. The childbearing CSP patients with a cesarean section history were evaluated by ultrasonography, with a gestational age of less than 10 weeks. Thirty-four patients receiving dilation and curettage (D&C) after UAE were enrolled into the D&C group, whereas 46 undergoing H/S and curettage after UAE were enrolled into the H/S group.Differences in success rate and decrease in the β-hCG level in serum on the second day of surgery were not significantly different between D&C and H/S groups (P > .05). Also, differences in side effect rate (except for the anesthesia-related side effects), intraoperative blood loss amount, postoperative bleeding time, and total length of hospital stay were not significant between 2 groups (P > .05). Compared with D&C group, H/S group had decreased postoperative length of hospital stay (P < .05), increased hospitalization cost (P < .05), and significantly elevated time of CSP mass disappearance (P < .05). In addition, 8 (18.19%) patients in H/S group developed anesthesia-related side effects.This study reveals no obvious difference between UAE + D&C and UAE + H/S in terms of the clinical efficacy and safety, except for the time of CSP mass disappearance and anesthesia-related side effects. The hospitalization cost is more expensive for UAE + H/S, but the postoperative length of stay is shorter for UAE + H/S. UAE + H/S is associated with the risk of anesthesia-associated side effects.
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Mai ZS, Chen YQ, Liao M, Ma C, Han YB. Early detection of a cesarean scar pregnancy with placenta increta by contrast-enhanced ultrasound in the first trimester: A case report and literature review. J Obstet Gynaecol Res 2021; 48:251-255. [PMID: 34655263 DOI: 10.1111/jog.15072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 11/30/2022]
Abstract
Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy, which is a long-term complication of cesarean section. Prompt and accurate diagnosis of CSP is important to decrease maternal mobility and mortality. However, it is difficult to make an early detection for CSP complicated with morbidly adherent placenta. Contrast-enhanced ultrasound with the advantage in blood flow imaging is low-cost, time-saving, safe and more accessible in clinical practice. Here, we report a case with early detection of CSP with placenta increta by contrast-enhanced ultrasound and its successful uterine-sparing surgical management.
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Affiliation(s)
- Zhen-Sheng Mai
- Department of Gynecology, The First People's Hospital of Foshan, Foshan, People's Republic of China
| | - Yun-Qing Chen
- Department of Gynecology, The First People's Hospital of Foshan, Foshan, People's Republic of China
| | - Min Liao
- Department of Gynecology, The First People's Hospital of Foshan, Foshan, People's Republic of China
| | - Cong Ma
- Department of Gynecology, The First People's Hospital of Foshan, Foshan, People's Republic of China
| | - Yu-Bin Han
- Department of Gynecology, The First People's Hospital of Foshan, Foshan, People's Republic of China
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12
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Yu L, Yang B, Xu Q, Teng Y, Xue Z. A study on the timing of uterine artery embolization followed by pregnancy excision for cesarean scar pregnancy: a prospective study in China. BMC Pregnancy Childbirth 2021; 21:697. [PMID: 34654394 PMCID: PMC8518328 DOI: 10.1186/s12884-021-04180-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 10/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cesarean scar pregnancy (CSP) remains a sporadic and special form of ectopic pregnancy in which the fertilized ovum is implanted on a previous cesarean scar within 12 weeks. This study aims to evaluate the optimal time interval between uterine artery embolization (UAE) and curettage modalities in order to provide the best clinical outcomes. METHODS From January 2018 to December 2020, we recruited 61 patients with CSP. They were randomly divided into two groups depending on whether the time interval between UAE and dilatation and curettage (D&C) requires additional hospitalization: 31 patients received prophylactic UAE followed by D&C on the same day (0-12 h; group A) and 30 patients need hospitalization (12-72 h; group B). The clinical characteristics, diagnostic data, and outcomes of the two groups were compared and analyzed. RESULTS A total of 59 (96.72%) cases had responded well to the first treatment. One patient in each arm undergone retreatment, but none of the 61 patients needed additional hysterectomy. There was no considerable relationship between the two groups with respect to the intraoperative hemorrhage during D&C, serum index (containing β-hCG, hemoglobin, CRP, and D-dimer) on the first day after D&C, side effects (containing fever and abdominal pain), renal, hepatic, and coagulation function, time of CSP residual mass disappearance, and hospitalization cost. The time of serum β-hCG resolution after surgery was 41.22 ± 14.97 days in group A and 66.67 ± 36.64 days in group B (P = 0.027), and group A treatment resulted in a shorten hospital stay as compared with group B (4.81 ± 2.74 days vs. 6.80 ± 2.14 days, P < 0.001). However, the average hourly serum β-hCG decrease rate within 24 h and the leukocytes on the first day after D&C in group B were superior than in group A (P < 0.050). CONCLUSION For patients with CSP, UAE followed by D&C on the same day (0-12 h) appears to have more advantages in hospitalization and recovery time, while the long time interval (12-72 h) may have a lower risk of inflammation and a more rapid decrease in serum β-hCG level within 24 h after D&C surgery. The treatment of CSP should be individualized based on the conditions of patients.
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Affiliation(s)
- Liping Yu
- The Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Bikang Yang
- The Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Qinyang Xu
- The Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Yincheng Teng
- The Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
| | - Zhuowei Xue
- The Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
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Cao S, Qiu G, Zhang P, Wang X, Wu Q. A Comparison of Transvaginal Removal and Repair of Uterine Defect for Type II Cesarean Scar Pregnancy and Uterine Artery Embolization Combined With Curettage. Front Med (Lausanne) 2021; 8:654956. [PMID: 34239887 PMCID: PMC8258109 DOI: 10.3389/fmed.2021.654956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/04/2021] [Indexed: 11/21/2022] Open
Abstract
Background: There is no consensus on a standardized therapy for type II cesarean scar pregnancy (CSP II). The objective of the present study was to evaluate the efficacy and safety and compare costs associated with transvaginal removal and repair (TRR) of uterine defect for CSP II to those of uterine artery embolization (UAE) and curettage. Methods: We conducted a retrospective study that included 87 patients diagnosed with CSP II and treated by performing UAE in combination with curettage and hysteroscopy (n = 53), or TRR (n = 34). Clinical data and outcomes were analyzed. Results: UAE and TRR groups exhibited similar success rates. The TRR group had significantly lower complication rates (30.19 vs. 8.82%, P < 0.05) and lower total costs (13,765.89 ± 2,029.12 vs. 9,063.82 ± 954.67, P < 0.05) than the UAE group. The anterior myometrium of the lower uterine segment was relatively thicker after performing TRR, and no patient suffered from recurrent CSP II. The proportion of patients in the TRR group who had full-term delivery without uterine rupture was 88.24% (30/34), while four patients failed to pregnancy. Conclusion: TRR is a safe and effective treatment method for patients with CSP II and presents a highly cost-effective outcome, especially for patients with future fertility desire.
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Affiliation(s)
- Shanshan Cao
- Tiantai People's Hospital of Zhejiang Province, Taizhou, China
| | - Guijing Qiu
- Tiantai People's Hospital of Zhejiang Province, Taizhou, China
| | - Peipei Zhang
- Tiantai People's Hospital of Zhejiang Province, Taizhou, China
| | - Xinyan Wang
- Department of Gynecology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Qing Wu
- Department of Gynecology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
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14
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Management of Cervical Ectopic Pregnancies: A Scoping Review. Obstet Gynecol 2021; 138:33-41. [PMID: 34259461 DOI: 10.1097/aog.0000000000004423] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/04/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate published cases of cervical ectopic pregnancy between 2000 and 2018 and compare management strategies and treatment success rates based on initial patient characteristics. METHODS PubMed, EMBASE, and Web of Science were searched to capture peer-reviewed citations published between 2000 and 2018. Cases reporting either β-hCG level, crown-rump length, or gestational sac diameter for each individual patient were included. Data regarding the article information, patient characteristics, treatment used, and outcomes were collected. Initial success was defined as resolution of the cervical ectopic pregnancy with the predefined treatment plan. Initial failure was defined as the requirement of additional unplanned interventions due to the predefined treatment plan not being successful. End success was defined as resolution of the cervical ectopic pregnancy without hysterectomy. RESULTS A total of 204 articles from 44 countries comprising 454 cases were reviewed. The initial β-hCG level ranged from 9 to 286,500, with a median of 14,773, and gestational age ranged from 4 to 18 weeks, with an average of 7 4/7 weeks (±2 0/7 weeks). In looking at initial success, compared with methotrexate alone, dilation, and curettage (odds ratio [OR] 2.26; 95% CI 2.64-10.45), dilation and curettage combined with uterine artery embolization (OR 4.85; 95% CI 2.06-11.44) and uterine artery embolization (OR 5.17; 95% CI 1.14-23.53) were more effective options. More than half of patients (50.2%) required multiple interventions, and 41 (9%) resulted in hysterectomy. CONCLUSIONS Management of cervical ectopic pregnancies should be guided by patient stability, β-hCG level, size of pregnancy, and fetal cardiac activity but may benefit from a planned multimodal approach.
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Tang Y, Zhang Y, Tang H, Che J, Feng H, Yao X, Chen Q. A Comparison of Ultrasound Guided Curettage With and Without Uterine Artery Embolization on Controlling Intraoperative Blood Loss for a Cesarean Scar Pregnancy Treatment: Study Protocol for a Randomized Clinical Trial. Front Endocrinol (Lausanne) 2021; 12:651273. [PMID: 34194390 PMCID: PMC8237711 DOI: 10.3389/fendo.2021.651273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/11/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Cesarean scar pregnancy affects 6% of all ectopic pregnancies in women with prior cesarean section, and there is currently no consensus on the optimal treatment. Options of surgical treatment have a risk of intraoperative blood loss; therefore, uterine artery embolization (UAE) has been considered as an option of reducing intraoperative blood loss. However, UAE may be overused in clinical practice, especially in China. We present this protocol for a randomized clinical trial investigating the necessity of performing UAE for cesarean scar pregnancy, in combination with surgical suction curettage, taking into account the different subtypes of cesarean scar pregnancy. We recently developed a risk-scoring system (QRS) to estimate intraoperative blood loss, with 93.8% sensitivity and 6.3% false negative. Through this randomized clinical trial, we will retrospectively validate the QRS score on predicting intraoperative blood loss. Methods and Analysis We propose undertaking a randomized clinical trial sequentially recruiting 200 patients. All the patients will randomly receive ultrasound guided curettage with or without UAE. Data on the subtypes of cesarean scar pregnancy (Types 1 and II and III) detected by ultrasound will be collected before operation. The score on estimating intraoperative blood loss assessed by our recently developed quantitative risk-scoring system (QRS) will be collected before the operation. We will primarily compare the duration of the operation, intraoperative blood loss, and complications between the two groups. We will also retrospectively analyze the association of subtypes of cesarean scar pregnancy and the options of treatment and validate the QRS score. Outcomes of subsequent pregnancy within the 2-year follow-up will be secondary outcomes. Trial Registration Number [website], identifier ChiCTR2100041654.
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Affiliation(s)
- Yunhui Tang
- Department of Family Planning, The Hospital of Obstetrics & Gynaecology, Fudan University, Shanghai, China
| | - Yi Zhang
- Department of Obstetrics & Gynaecology, The University of Auckland, Auckland, New Zealand
| | - Hanqing Tang
- School of Medicine, Nantong University, Nantong, China
| | - Jiahui Che
- Department of Gynaecology, The Hospital of Obstetrics & Gynaecology, Fudan University, Shanghai, China
| | - Hua Feng
- Unit of Cervical Disease, The Hospital of Obstetrics & Gynaecology, Fudan University, Shanghai, China
| | - Xiaoying Yao
- Department of Family Planning, The Hospital of Obstetrics & Gynaecology, Fudan University, Shanghai, China
| | - Qi Chen
- Department of Obstetrics & Gynaecology, The University of Auckland, Auckland, New Zealand
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16
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Wu J, Ye J, OuYang Z, Wan Z, Zhang Q, Zhong B, Wei S. Outcomes of reproduction following cesarean scar pregnancy treatment: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021; 262:80-92. [PMID: 33993066 DOI: 10.1016/j.ejogrb.2021.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/01/2021] [Accepted: 05/06/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To explore the reproductive outcomes of women with a history of cesarean scar pregnancy (CSP) and the influence of various treatments on subsequent pregnancy outcomes. STUDY DESIGN The PubMed, Embase, Medline, Cochrane Library and ClinicalTrial.gov databases were searched for studies with the outcomes of pregnancy after CSP treatment. Studies that reported reproductive outcomes after CSP with more than 5 followed cases were included. The main data collected includes the treatment methods of CSP and subsequent pregnancy outcomes. The main information includes intrauterine pregnancy, recurrent CSP (RCSP), and spontaneous miscarriage, while the secondary information includes complications during pregnancies and the outcomes of childbirths. According to different treatments (conservative treatment, surgical treatment without resection of cesarean scar, and surgical treatment with resection of cesarean scar), a stratified analysis was carried out to compare the influence of treatments on subsequent pregnancy outcomes. RESULTS A total of 32 studies including 3380 cases of CSP met the inclusion criteria, of which 583 cases conceived again after treatment (including 292 cases of unexpected pregnancy), and finally 178 cases delivered successfully. The follow-up time ranged from 3 to 72 months. Among women with fertility requirements, a total of 291 cases in 403 women were successfully conceived during the follow-up period in 15 studies. Thence the pregnancy rate of women with fertility requirements was 76.2 %. Among all of the 583 successfully conceived women, 83.4 % of them had intrauterine pregnancy, while 15.3 % of cases were RCSP. The total ectopic pregnancy rate reached 16.6 %, covering RCSP and other sites of ectopic pregnancy. 14.6 % of intrauterine pregnancy experienced spontaneous miscarriage. The intrauterine pregnancy rates of the conservative treatment group, the surgical treatment without resection of cesarean scar group, and the surgical treatment with resection of cesarean scar group were 93.1 %, 80.1 % and 86.0 % respectively; the corresponding RCSP rates were 6.9 %, 15.6 % and 14.0 % respectively; and the corresponding spontaneous miscarriage rates were 20.7 %, 13.9 % and 22.2 % respectively. CONCLUSION The outcomes of reproduction after CSP included intrauterine pregnancy, RCSP and other sites of ectopic pregnancy. Women with a history of CSP still have a high pregnancy rate, but the risk of RCSP and spontaneous miscarriage is also increased. It is impossible to clarify the effect of different treatments on subsequent pregnancy. Whether the resection and repair of cesarean scar can ameliorate reproductive outcomes needs to be further assessed. Further large-scale prospective studies, even RCTs with long-term follow-up are needed to expound the outcomes of reproduction after CSP and the effect of different treatments on subsequent reproductive outcomes.
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Affiliation(s)
- Jiawen Wu
- Department of Gynecology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Jianbin Ye
- Department of Intensive Care Unit, Puning People's Hospital, Puning, China
| | - Zhenbo OuYang
- Department of Gynecology, Guangdong Second Provincial General Hospital, Guangzhou, China.
| | - Zixian Wan
- Department of Gynecology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Qiushi Zhang
- Department of Gynecology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Biting Zhong
- Department of Gynecology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Shiyuan Wei
- Department of Gynecology, Guangdong Second Provincial General Hospital, Guangzhou, China
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Clinical outcome and analysis of procedural failure during uterine artery chemoembolisation as a treatment of caesarean scar pregnancy. Wideochir Inne Tech Maloinwazyjne 2021; 16:243-248. [PMID: 33786140 PMCID: PMC7991929 DOI: 10.5114/wiitm.2020.100713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/16/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction Caesarean scar pregnancy (CSP) is a relatively rare yet life-threatening condition in which the embryo is implanted in the scar after caesarean section. Recent studies have reported that uterine artery chemoembolisation (UAC) can be safe and effective method in treating CSP. Aim To present the clinical outcome of UAC with a mixture of methotrexate and gelatine sponge for the treatment of CSP and analysis of procedural failure. Material and methods Forty-one patients diagnosed with CSP were treated with selective endovascular chemoembolisation of uterine arteries. Short- and long-term results, reasons for procedural failure, and clinical outcome were analysed. Results Primary procedure failed in 7 out of 41 (17%) cases. In 4 cases additional blood supply to the CSP was disclosed; 3 out of 4 from an ovarian artery and one from a superior vesical artery. In other 3 patients, reperfusion of uterine arteries was observed. All these 7 patients underwent successful secondary embolisation. The majority of the followed-up patients reported regular menses after the intervention. Four women suffered from amenorrhoea and 2 from hypomenorrhoea that continued after 90 days. Twelve patients expressed the desire for subsequent pregnancy. From this group, 5 conceived within a year of the procedure. The rest did not achieve a pregnancy. Conclusions UAC proved to be a safe and effective method and should be considered as an option for CSP treatment, especially for women hoping to preserve their fertility. However, the presence of collateral blood supply should always be considered.
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Wu Q, Liu X, Zhu L, Zhu Y, Mei T, Cao S, Shen Y, Ding J, Lin T. Clinical Assessment of Ultrasound-Guided Local Lauromacrogol Injection Combined With Curettage and Hysteroscopy for Cesarean Scar Pregnancy. Front Pharmacol 2020; 11:601977. [PMID: 33408631 PMCID: PMC7779759 DOI: 10.3389/fphar.2020.601977] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/24/2020] [Indexed: 12/17/2022] Open
Abstract
Background: To evaluate the efficacy, safeness and cost of ultrasound-guided local lauromacrogol injection (USG-LLI) combined with curettage and hysteroscopy for cesarean scar pregnancy (CSP). Methods: This was a retrospective study included 151 CSP patients diagnosed with CSP from June 2017 to December 2019, and treated by USG-LLI (n = 86) or uterine artery embolization (UAE) (n = 65) combined with curettage and hysteroscopy. Clinical data and outcome were analyzed. Results: There were no significant differences in basic clinical characteristics in the two groups. Two groups showed the similar success rates. USG-LLI group, compared with UAE group had significantly lower complication rates (9.30 vs. 44.62%), lower total costs (both medical and non-medication cost) (p < 0.05). Conclusions: USG-LLI combined with curettage and hysteroscopy is a feasible method to treat CSP with minimal invasion and high efficacy. Moreover, compared with curettage after UAE, USG-LLI exhibited lower complication rate and required fewer expenses.
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Affiliation(s)
- Qing Wu
- Department of Gynecology, Zhejiang Provincial Peoples' Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Xia Liu
- Department of Obstetrics and Gynecology, Fujian Provincial Hospital, Clinical Medical School of Fujian Medical University, Fuzhou, China
| | - Lin Zhu
- Department of Obstetrics and Gynecology, Fujian Provincial Hospital, Clinical Medical School of Fujian Medical University, Fuzhou, China
| | - Yichen Zhu
- Zhejiang University School of Medicine, Hangzhou, China
| | - Tingting Mei
- Department of Gynecology, Zhejiang Provincial Peoples' Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Shanshan Cao
- Tiantai People's Hospital of Zhejiang Province, Zhejiang, China
| | - Yan Shen
- Department of Gynecology, Zhejiang Provincial Peoples' Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Jun Ding
- Department of Gynecology, Zhejiang Provincial Peoples' Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Tan Lin
- Department of Obstetrics and Gynecology, Fujian Provincial Hospital, Clinical Medical School of Fujian Medical University, Fuzhou, China
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19
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Zhang Y, Zhang Z, Liu X, Zhang L, Hong F, Lu M. Risk factors for massive hemorrhage during the treatment of cesarean scar pregnancy: a systematic review and meta-analysis. Arch Gynecol Obstet 2020; 303:321-328. [PMID: 33219842 DOI: 10.1007/s00404-020-05877-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 11/04/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Cesarean scar pregnancy (CSP) is one of the serious complications associated with cesarean delivery (CD). This meta-analysis aims to identify risk factors associated with massive hemorrhage during the CSP treatment. METHODS Eight electronic databases were searched for case-control studies published before December 31th, 2018, which compared the possible factors causing massive bleeding during the CSP treatment. Quantitative synthesis was performed by RevMan 5.3. Sensitivity analysis and publication bias were performed by Stata 12.0. RESULTS Total 20 case - control studies including 3101 CSP patients with previous CD met the inclusion criteria. Bleeding group had 573 patients and the control group had 2528 patients. The risk factors for massive bleeding during CSP treatment included multiple gravidities (MD = 0.15, 95% CI 0.03-0.28, P = 0.73), big maximum diameter of gestation sac (MD = 18.49 mm, 95%CI 15.34-21.65, P < 0.01), high gestational days (MD = 8.98 days, 95% CI 4.12-13.84, P < 0.01), high β-HCG level (MD = 21.39 IU/ml, 95% CI 7.36-35.41, P = 0.03; MD = 3.02 U/ml, 95% CI 0.21-5.84, P < 0.01) and rich blood flow around the lesion (OR = 6.73, 95% CI 3.93-11.51, P = 0.59). While, thick myometrium (MD = - 4.94 mm, 95% CI - 6.12 to - 3.75, P < 0.01) may be protective factor. CONCLUSIONS Multiple gravidities, big gestation sac, large gestational days, high serum β-HCG level, abundant blood supply to pregnancy sac and thin myometrium maybe the risk factors for massive bleeding during the CSP treatment.
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Affiliation(s)
- Yuan Zhang
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, China.,Clinical Research Center, Shandong University, Jinan, China
| | - Zhongyun Zhang
- Department of Endocrinology and Metabolism, Ruijin Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai, China.,School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaoyan Liu
- Department of Obstetrics, Qilu Hospital of Shandong University, Jinan, China
| | - Lei Zhang
- Department of Obstetrics, Second Hospital of Shandong University, Jinan, China
| | - Fanzhen Hong
- Department of Obstetrics, Second Hospital of Shandong University, Jinan, China
| | - Ming Lu
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China. .,Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, China. .,Clinical Research Center, Shandong University, Jinan, China.
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20
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Gerday A, Lourtie A, Pirard C, Laurent P, Wyns C, Jadoul P, Squifflet JL, Dolmans MM, Van Gossum JP, Hammer F, Luyckx M. Experience With Medical Treatment of Cesarean Scar Ectopic Pregnancy (CSEP) With Local Ultrasound-Guided Injection of Methotrexate. Front Med (Lausanne) 2020; 7:564764. [PMID: 33224958 PMCID: PMC7671087 DOI: 10.3389/fmed.2020.564764] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/21/2020] [Indexed: 11/23/2022] Open
Abstract
Objective: Ectopic pregnancy within Cesarean section scars is a rare condition. Late diagnosis carries significant risk of bleeding with poor prognosis for survival. There is no consensus on the management of this type of pregnancy. Historically, our facility offered an intra-muscular injection of methotrexate that resulted in a significant failure rate and later need for surgery. We hypothesized that injecting methotrexate directly into the gestational sac would improve the success rate of the treatment. Patients and Methods: This retrospective, uni-centric study examined nine patients aged between 33 and 42 years (mean age = 36.5 years) with Cesarean scar ectopic pregnancy (CSEP) between 2010 and 2018. CSEP was diagnosed by transvaginal ultrasound at a mean gestational age of 8w0/7. CSEP was treated under general anesthetic by ultrasound-guided methotrexate injection directly into the gestational sac. HCG levels and subsequent childbearing were monitored post-treatment. Results: Half of the patients were asymptomatic at the time of diagnosis. All patients tolerated treatment well and all ectopic pregnancies were successfully removed. HCG levels returned to negative within 3 months without additional medical or surgical intervention. The post-treatment pregnancy rate was 50%. Discussions/Conclusions: Our findings indicate that local ultrasound-guided injection of methotrexate into the gestational sac is a safe and effective therapeutic approach when performed by a trained team on a hemodynamically stable patient in the early stages of CSEP.
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Affiliation(s)
- Amandine Gerday
- Department of Gynaecology and Andrology, Cliniques Universitaires Saint Luc, Woluwe-Saint-Lambert, Belgium.,Institut de Recherche Clinique Pôle GYNE, Catholic University of Louvain, Brussels, Belgium
| | - Amélie Lourtie
- Department of Gynaecology and Andrology, Cliniques Universitaires Saint Luc, Woluwe-Saint-Lambert, Belgium
| | - Céline Pirard
- Department of Gynaecology and Andrology, Cliniques Universitaires Saint Luc, Woluwe-Saint-Lambert, Belgium
| | - Pascale Laurent
- Department of Gynaecology and Andrology, Cliniques Universitaires Saint Luc, Woluwe-Saint-Lambert, Belgium
| | - Christine Wyns
- Department of Gynaecology and Andrology, Cliniques Universitaires Saint Luc, Woluwe-Saint-Lambert, Belgium.,Institut de Recherche Clinique Pôle ANDRO, Catholic University of Louvain, Brussels, Belgium
| | - Pascale Jadoul
- Department of Gynaecology and Andrology, Cliniques Universitaires Saint Luc, Woluwe-Saint-Lambert, Belgium
| | - Jean-Luc Squifflet
- Department of Gynaecology and Andrology, Cliniques Universitaires Saint Luc, Woluwe-Saint-Lambert, Belgium
| | - Marie-Madeleine Dolmans
- Department of Gynaecology and Andrology, Cliniques Universitaires Saint Luc, Woluwe-Saint-Lambert, Belgium.,Institut de Recherche Clinique Pôle GYNE, Catholic University of Louvain, Brussels, Belgium
| | - Jean-Paul Van Gossum
- Department of Gynaecology and Andrology, Cliniques Universitaires Saint Luc, Woluwe-Saint-Lambert, Belgium.,Department of Gynaecology, Clinique Saint Jean, Brussels, Belgium
| | - Frank Hammer
- Department of Radiology, Cliniques Universitaire Saint Luc, Woluwe-Saint-Lambert, Belgium
| | - Mathieu Luyckx
- Department of Gynaecology and Andrology, Cliniques Universitaires Saint Luc, Woluwe-Saint-Lambert, Belgium.,Institut de Recherche Clinique Pôle GYNE, Catholic University of Louvain, Brussels, Belgium.,Tumor Infiltrating Lymphocytes Group, Institut de Duve, Catholic University of Louvain, Brussels, Belgium
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21
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Ou J, Peng P, Li C, Teng L, Liu X. Assessment of the necessity of uterine artery embolization during suction and curettage for caesarean scar pregnancy: a prospective cohort study. BMC Pregnancy Childbirth 2020; 20:378. [PMID: 32600442 PMCID: PMC7325163 DOI: 10.1186/s12884-020-03062-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 06/16/2020] [Indexed: 02/07/2023] Open
Abstract
Background Uterine artery embolization (UAE) followed by suction and curettage is a common conservative treatment for caesarean scar pregnancy (CSP), but the advantages of suction and curettage alone are underestimated due to the lack of standards for selecting appropriate cases for which this approach would be applicable. We sought to identify indicators with which to assess the need for UAE during suction and curettage. Methods The prospective cohort consisted of 105 women diagnosed with CSP in Peking Union Medical College Hospital between January 2016 and September 2018 who were followed up until 60 days after surgery. The main outcome was the therapy used, and secondary outcomes included recovery, bleeding, surgery time, length of hospital stay, and total cost. Results We found that β-human chorionic gonadotropin (β-hCG) levels were significantly lower (P < 0.05), foetal cardiac activity was significantly lower (P < 0.05), the myometrial layer was significantly thicker (P < 0.05), expenditures were lower and lengths of hospital stay were shorter in patients who received suction and curettage alone (the non-UAE group) than in those who received UAE followed by suction and curettage (the UAE+ group). In addition, for CSP patients, UAE might be less necessary when the myometrial thickness is ≥2 mm and the gestational sacmeasures ≤5 cm, and suction and curettage alone may be safer for these patients. Conclusion Suction and curettage alone is a more suitable option than UAE followed by suction and curettage because the former carries a lower cost, shorter length of hospital stay, and lower risk of adverse events. Regarding risk factors, patients with a lower uterine segment thickness ≥ 2 mm and a gestational mass diameter ≤ 5 cm have an increased probability of being successfully treated with suction and curettage alone.
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Affiliation(s)
- Jie Ou
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 ShuaiFu Road, Dongcheng District, Beijing, People's Republic of China
| | - Ping Peng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 ShuaiFu Road, Dongcheng District, Beijing, People's Republic of China
| | - Chunying Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 ShuaiFu Road, Dongcheng District, Beijing, People's Republic of China
| | - Lirong Teng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 ShuaiFu Road, Dongcheng District, Beijing, People's Republic of China
| | - Xinyan Liu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 ShuaiFu Road, Dongcheng District, Beijing, People's Republic of China.
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22
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Morlando M, Buca D, Timor-Tritsch I, Cali G, Palacios-Jaraquemada J, Monteagudo A, Khalil A, Cennamo C, La Manna V, Liberati M, D'Amico A, Nappi L, Colacurci N, D'Antonio F. Reproductive outcome after cesarean scar pregnancy: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2020; 99:1278-1289. [PMID: 32419158 DOI: 10.1111/aogs.13918] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 12/23/2022]
Abstract
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.
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Affiliation(s)
- Maddalena Morlando
- Department of Woman, Child and General and Special Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Danilo Buca
- Center for High Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Ilan Timor-Tritsch
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, New York University SOM, New York, NY, USA
| | - Giuseppe Cali
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Villa Sofia Cervello, Palermo, Italy.,Department of Obstetrics and Gynecology, Arnas Civico Hospital, Palermo, Italy
| | - Jose Palacios-Jaraquemada
- Center for Medical Education and Clinical Research (CEMIC), University Hospital, Buenos Aires, Argentina
| | - Ana Monteagudo
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Asma Khalil
- Fetal Medicine Unit, St George's Hospital, London, UK
| | - Carmen Cennamo
- Department of Woman, Child and General and Special Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Viviana La Manna
- Department of Woman, Child and General and Special Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco Liberati
- Center for High Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Alice D'Amico
- Center for High Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Luigi Nappi
- Fetal Medicine Unit, Department of Medical and Surgical Sciences, Department of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
| | - Nicola Colacurci
- Department of Woman, Child and General and Special Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco D'Antonio
- Center for High Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
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23
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Surgical management of first-trimester bleeding in a heterotopic caesarean scar pregnancy: A case report and review of literature. Case Rep Womens Health 2020; 27:e00209. [PMID: 32420043 PMCID: PMC7217994 DOI: 10.1016/j.crwh.2020.e00209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 02/07/2023] Open
Abstract
Heterotopic caesarean scar pregnancy (HCSP) is very rare, with only 24 cases reported in the literature. Optimal management is yet to be determined. We describe a 38-year-old woman, G2P1, who presented with vaginal bleeding and haemodynamic instability at 9 weeks of gestation in a HCSP. She was managed with ultrasound-guided lower-segment curettage and bilateral uterine artery ligation. The patient's pregnancy was complicated by preterm rupture of membranes and shortened cervix at 27 weeks of gestation. This necessitated preterm delivery, with subsequent neonatal death attributed to extreme prematurity. The patient later had a spontaneously conceived pregnancy, which was complicated by placenta percreta requiring elective caesarean hysterectomy at 34 weeks of gestation. This is, to our knowledge, the first case report describing preservation of the intrauterine pregnancy and future fertility in a patient with a HCSP and significant first-trimester bleeding. We suggest that ultrasound-guided lower-segment curettage may be a suitable management option for carefully selected patients with HCSP in a tertiary centre. All patients with HCSP require judicious counselling regarding the risk of morbidly adherent placenta and need for tertiary-level obstetric management in future pregnancies. First trimester bleeding in heterotopic caesarean scar pregnancy Surgical management of heterotopic caesarean scar pregnancy Ultrasound guided curettage with preservation of concurrent intrauterine pregnancy
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24
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Zhang G, Li J, Tang J, Zhang L, Wang D, Sun Z. Role of collateral embolization in addition to uterine artery embolization followed by hysteroscopic curettage for the management of cesarean scar pregnancy. BMC Pregnancy Childbirth 2019; 19:502. [PMID: 31842804 PMCID: PMC6915915 DOI: 10.1186/s12884-019-2590-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 11/11/2019] [Indexed: 05/30/2023] Open
Abstract
Background The aim of this study was to assess the feasibility, safety and outcome of the embolization of non-gonadal collateral supplying gestational sac (GS) in addition to uterine artery embolization (UAE), followed by hysteroscopic curettage for the management of cesarean scar pregnancy (CSP). Methods A retrospective study was undertaken from January 2012 to September 2018 in 24 CSP patients in whom non-gonadal collaterals supplying GS were identified by arterial angiography performed immediately after UAE. These patients underwent attempt collateral embolization in addition to UAE, followed by hysteroscopic curettage for the management of CSP. The 24 patients were divided into two groups based on whether they underwent technically successful collateral embolization (UAE-SCE group) or failed collateral embolization (UAE-FCE group) in addition to UAE. The baseline characteristics and clinical outcomes including time for serum β-human chorionic gonadotropin (β-hCG) levels normalization, blood loss, secondary anemia, and pelvic pain were compared between the two groups. The paired t test and Man Whitney test were used for comparisons of discrete and numerical variables, respectively. Results Collateral embolization was techinically successful in 16 (66.7%, 16/24) patients and failed in the other 8 (33.3%, 8/24) patients. There were no significant differences between the two groups in baseline characteristics. The mean blood loss and secondary anemia in the UAE-SCE group were significantly less than UAE-FCE group. No significant difference was found between the two groups in the mean time for β-hCG levels normalization and pelvic pain. Conclusions During the management of UAE combined with hysteroscopic curettage for CSP, additional embolization of non-gonadal collateral supplying GS during UAE is feasible and safe in patients with non-gonadal collateral supplying GS, and the additional embolization of the collateral may reduce blood bloss related to hysteroscopic curettage.
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Affiliation(s)
- Guodong Zhang
- Department of Interventional Radiology, Shandong Medical Imaging Research Institute Affiliated to Shandong University, Jinan, 250021, People's Republic of China
| | - Jijun Li
- Department of Interventional Radiology, Shandong Medical Imaging Research Institute Affiliated to Shandong University, Jinan, 250021, People's Republic of China
| | - Jun Tang
- Department of Interventional Radiology, Shandong Medical Imaging Research Institute Affiliated to Shandong University, Jinan, 250021, People's Republic of China
| | - Lei Zhang
- Department of Interventional Radiology, Shandong Medical Imaging Research Institute Affiliated to Shandong University, Jinan, 250021, People's Republic of China
| | - Dechao Wang
- Department of Interventional Radiology, Shandong Medical Imaging Research Institute Affiliated to Shandong University, Jinan, 250021, People's Republic of China
| | - Zengtao Sun
- Department of Interventional Radiology, Shandong Medical Imaging Research Institute Affiliated to Shandong University, Jinan, 250021, People's Republic of China.
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25
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Xiao X, Feng Z, Li T, Yi B, Zhang S, Wang W. Comparing the Efficacy and Safety of High-Intensity Focused Ultrasound and Uterine Artery Embolization in Caesarean Scar Pregnancy: A Meta-analysis. Adv Ther 2019; 36:1314-1325. [PMID: 31049875 DOI: 10.1007/s12325-019-00959-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION High-intensity focused ultrasound (HIFU) followed by curettage and uterine artery embolization (UAE) followed by curettage are two methods of treatment for caesarean scar pregnancy (CSP). There is currently no consistent evidence concerning any difference in efficacy and safety between UAE and HIFU. Therefore, a meta-analysis was performed to compare the efficacy and safety of HIFU and UAE in the treatment of CSP. METHODS Studies published in PubMed, Cochrane, Embase, Web of Science, Chinese BioMedical Literature Service System, and Chinese National Knowledge Infrastructure databases were searched and the main outcomes in the studies were extracted. RESULTS Of 8 studies and 715 patients included in this study, 388 and 327 patients were in the HIFU group and UAE groups, respectively. Compared with the UAE group, patients in the HIFU group had less blood loss [weighted mean difference (WMD) = - 22.58 ml; 95% confidence interval (CI) - 44.45 to - 0.70; p < 0.05), lower incidence of adverse events [odds ratio (OR) = 0.17; 95% CI 0.06-0.46; p < 0.05); shorter duration of hospital stay (WMD = - 0.96 days; 95% CI - 1.88 to - 0.03; p < 0.05); and a longer β-human chorionic gonadotropin normalisation time (WMD = 9.59 days; 95% CI 1.66-17.52; p < 0.05). CONCLUSION Patients in the HIFU group appeared to have better outcomes than those in the UAE group; thus, HIFU may be a priority option for the early management of CSP. However, this needs to be confirmed by multi-centre, large-scale randomised controlled trials.
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Affiliation(s)
- Xiaoyi Xiao
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhichao Feng
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Ting Li
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Bin Yi
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shengwang Zhang
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Wei Wang
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, China.
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26
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Qiu J, Fu Y, Xu J, Huang X, Yao G, Lu W. Analysis on clinical effects of dilation and curettage guided by ultrasonography versus hysteroscopy after uterine artery embolization in the treatment of cesarean scar pregnancy. Ther Clin Risk Manag 2019; 15:83-89. [PMID: 30662266 PMCID: PMC6327891 DOI: 10.2147/tcrm.s184387] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to investigate the efficiency, complications, and subsequent fertility outcomes of two methods in treating patients with cesarean scar pregnancy (CSP) after receiving uterine artery embolization (UAE) treatment. Patients and methods A total of 62 CSP patients who visited our hospital and underwent UAE from January 2013 to January 2018 were retrospectively analyzed. Patients were either treated by dilation and curettage (D&C) guided by ultrasonography or hysteroscopy. The differences of related clinical indicators, clinical efficacy, complications, and subsequent fertility outcomes between the two groups were analyzed. Results The rates of therapeutic success of the ultrasonography group and hysteroscopy group were 84.6% and 95.7%, respectively, the difference was not statistically significant (P=0.243). However, the intraoperative blood loss, duration of hospitalization, and overall complications were significantly lower in hysteroscopy group compared with D&C guided by ultrasonography group (P<0.05 for all). Meanwhile, hysteroscopy had the advantage of discovering potential diverticulum in the lower segment of anterior wall of uterus (P<0.001). Conclusion D&C guided by ultrasonography or hysteroscopy for the treatment of CSP after UAE resulted in similarly good clinical outcomes. Compared with treatment of D&C guided by ultrasonography, hysteroscopy had less complications and had the advantages of discovering diverticulum. It can be used as an effective way for the treatment of CSP.
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Affiliation(s)
- Jian Qiu
- Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, China, .,Department of Obstetrics and Gynaecology, Huzhou Central Hospital, Huzhou, Zhejiang 313000, China
| | - Yunfeng Fu
- Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, China,
| | - Jiewei Xu
- Department of General Surgery, Huzhou Central Hospital, Huzhou, Zhejiang 313000, China
| | - Xiaohong Huang
- Department of Obstetrics and Gynaecology, Huzhou Central Hospital, Huzhou, Zhejiang 313000, China
| | - Guorong Yao
- Department of Obstetrics and Gynaecology, Huzhou Central Hospital, Huzhou, Zhejiang 313000, China
| | - Weiguo Lu
- Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, China,
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