Cesarean scar pregnancy associated with an impending uterine rupture diagnosed with 3-dimensional ultrasonography

Research trends of pregnancy with scarred uterus after cesarean: a bibliometric analysis from 1999 to 2018

BACKGROUND

In recent years, the number of women who are pregnant again with the history of cesarean section, has increased year by year in China. Scarred uterine attracts much attention due to its particularity. This study aimed to understand the knowledge domain and development trends of scarred uterus after cesarean section.

METHODS

Data were obtained from the Web of Science Core Collection databases (WoSCCd) including SSCI and SCI-Expanded. We carried out a comprehensive literature retrieval using index words as follows: "TI=((((prior) OR (previous) OR (after) OR (post)) AND ((cesarean) OR (caesarean))) OR (scarred uterus) OR ((uterine) AND ((scar) OR (scarring) OR (wound))))". The time interval for the search was from 1999 to 2018, totally 20 years. A document type was only article and the language of article was English. All electronic searches were performed on 15 May 2019. CiteSpace, HistCite, and VOSviewer software were used to facilitate the analysis.

RESULTS

The analysis included 1938 bibliographic records. The annual number of publications exhibited the solid increase. A total of 84 countries contributed to the overall published output during the study period. USA published the highest number of publications (n = 508, 26.2%), which also had the highest total global citation score (10,826). American Journal of Obstetrics and Gynecology, Obstetrics and Gynecology, and Journal of Maternal-fetal & Neonatal Medicine were the top three journals that published the articles. The top 10 productive institutions, such as Northwestern University, Tel Aviv University, and Karolinska Institute were located mainly in USA, Israel, and Sweden, and top 10 authors originated totally from USA. Vaginal birth after cesarean, uterine rupture, painless labor, and scar pregnancy were research hotspots and may be promising in the next few years.

CONCLUSIONS

This bibliometrics provides a comprehensive analysis that delineates the scientific productivity, collaboration, and research hotspots about scarred uterus after cesarean section, which is very helpful to focus on the future research direction.

Successful management of cesarean scar pregnancy with vacuum extraction under ultrasound guidance

Aim

Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy. The gestational sac is implanted in the myometrium at the site of a previous cesarean section. Mothers with CSP are faced with risks of unpredictable massive bleeding or more fatal complications. The purpose of this retrospective study was to assess the feasibility, efficacy, and reliability of the intraoperative ultrasound‐guided vacuum aspiration method as an effective treatment option for CSP.

Methods

We undertook a retrospective analysis of CSP patients who had undergone the vacuum aspiration method, by reviewing patient records from the period October 2015 to January 2018. All of the operations were carried out under general anesthesia, with patients in the lithotomy position, using suprapubic ultrasonography guidance. A vacuum aspirator was used to aspirate the whole pregnancy material without perforating the previous cesarean section scar.

Results

Ten women with CSP were managed successfully by ultrasound‐guided vacuum extraction without complications or further interventions, such as reoperation or methotrexate administration. Three of the 10 patients needed uterine Foley catheter tampon (50 cc) for 4 h after vacuum extraction alone was applied. During the study period, two additional patients who did not meet the criteria for the vacuum extraction method alone were managed with methotrexate plus vacuum application. Because of the rarity of the condition, the majority of CSPs are case reports or small case series reported in published works, with no consensus on the preferred course of treatment.

Conclusion

The vacuum extraction method seems to be a good and practical way of treating CSP. Comparisons of efficacy should be undertaken but large sample sizes are required. We hope this study brings a new perspective for larger sample‐sized studies, considering the technique is feasible and applicable.