1
|
Zhou C, Li X, Mo Y, Wei F. The value of ultrasound parameters in predicting the efficacy of transabdominal ultrasound-guided suction curettage alone in the treatment of cesarean scar pregnancy. J Obstet Gynaecol Res 2024; 50:948-954. [PMID: 38520306 DOI: 10.1111/jog.15927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE To investigate the value of ultrasound parameters in assessing the efficacy of transabdominal ultrasound (TAUS)-guided suction curettage alone for cesarean scar pregnancy (CSP). METHODS Secondary retrospective analysis of a prospective study consisted of 137 women diagnosed with CSP who were performed TAUS-guided suction curettage alone for the first time at Maternity and Child Health Care of Guangxi Zhuang Autonomous Region in China. Prior to surgery, an ultrasound examination was conducted. Based on the need for secondary intervention, the patients were categorized into failure group and success group, and the predictive factors for failure of TAUS-guided suction curettage alone were analyzed. RESULTS Multivariate logistic regression showed that maximum diameter of the gestational sac>29 mm (odds ratio [OR] = 4.043, 95% CI: 1.100-14.862), residual myometrium thickness ≤1.8 mm (OR = 3.719, 95% CI: 1.148-12.048) and chorionic villi thickness at the scar >4.7 mm (OR = 15.327, 95% CI: 4.617-50.881) were independent predictors of failure in TAUS-guided suction curettage alone for CSP. Furthermore, the logistic regression model that was jointly constructed by these three predictors demonstrated an area under the curve, sensitivity, specificity, and Youden index of 0.913, 0.912, 0.864, and 0.776, respectively. CONCLUSION The maximum diameter of the gestational sac, residual myometrium thickness, and chorionic villi thickness at the scar has certain predictive efficacy of TAUS-guided suction curettage alone for CSP. Nevertheless, it is more valuable to apply the model of this study, composed of the three ultrasound parameters, for this prediction purpose.
Collapse
Affiliation(s)
- Chunqiao Zhou
- Department of Ultrasonography, Maternity and Child Health Care of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Xinyan Li
- Department of Ultrasonography, Maternity and Child Health Care of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yu'ning Mo
- Department of Ultrasonography, Maternity and Child Health Care of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Fangtao Wei
- Department of Ultrasonography, Maternity and Child Health Care of Guangxi Zhuang Autonomous Region, Nanning, China
| |
Collapse
|
2
|
Carletti V, Yacoub V, Lopizzo P. Ultrasound-guided suction curettage followed by cervico-isthmic placement of foley three-way catheter for cesarean scar pregnancy's treatment. Retrospective study. J Gynecol Obstet Hum Reprod 2024:102746. [PMID: 38369245 DOI: 10.1016/j.jogoh.2024.102746] [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: 11/14/2023] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVES Cesarean scar pregnancy (CSP) is a rare dangerous condition with still no consensus on standard treatment. Suction curettage has been used as the first-line treatment for CSP with controversial outcomes. This study evaluates efficacy of ultrasound-guided suction curettage (UGSC) followed by cervical-isthmic placement of silicon semirigid three-way foley catheter. MATERIALS AND METHODS This study included 24 women with CSP. Preoperative ultrasound study was conducted. UGSC followed by placement of catheter was performed in all patients. The success rate and incidence of major complication, surgical time and hospital stay were recorded. RESULTS The success rate of UGSC followed by placement of foley catheter was 100%, effectively reduced major complications and none of the patients had a blood loss higher than 900 ml. Median hospital stay was 2 days and median foley stay was 1 day. Surgery had limited last with a median of 17 minutes. CONCLUSION UGSC followed by foley placement is a safe effective treatment for CSP with a clinical resolution of 100%. The catheter is easy to place under ultrasound guidance and prevents bleeding, reducing major procedures to solve the bleeding. Suction curettage in CSP treatment should be performed under ultrasound guidance and followed by cervical-isthmic placement of foley balloon.
Collapse
Affiliation(s)
- Valerio Carletti
- Department of Obstetrics and Gynecology, "Tor Vergata" University, Rome, Italy; Department of Obstetrics and Gynecology, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy.
| | - Veronica Yacoub
- Department of Obstetrics and Gynecology, "Tor Vergata" University, Rome, Italy; Department of Obstetrics and Gynecology, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| | - Paola Lopizzo
- Department of Obstetrics and Gynecology, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| |
Collapse
|
3
|
Timor-Tritsch IE, Kaelin Agten A, Monteagudo A, Calỉ G, D'Antonio F. The use of pressure balloons in the treatment of first trimester cesarean scar pregnancy. Best Pract Res Clin Obstet Gynaecol 2023; 91:102409. [PMID: 37716338 DOI: 10.1016/j.bpobgyn.2023.102409] [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: 02/20/2023] [Revised: 08/02/2023] [Accepted: 08/17/2023] [Indexed: 09/18/2023]
Abstract
Cesarean scar pregnancy (CSP) is among the most severe complications of cesarean delivery. CSP refers to the abnormal implantation of the gestational sac in the area of the prior cesarean delivery (CD), potentially leading to severe hemorrhage, uterine rupture, or development of placenta accreta spectrum disorders (PAS). The management of women with CSP has not been standardized yet. In women who opted for termination, discussion about the treatments should consider maternal symptoms, gestational age at intervention, and the future reproductive risk. A multitude of treatments, either medical or surgical, for CSP has been reported in the published literature. The present review aims to provide up-to-date information on a recently introduced minimally invasive treatments for CSP, including the single and double balloon catheter. The methodology of using the single or double catheter is described in a step-by-step fashion illustrated by pictures as well as video recordings. Both catheters have their deserved place to be used as a primary method for terminating scar pregnancies as well as using them as adjuncts to other treatments. They were successfully used by multiple individual practitioners and institutions due to their simplicity and low complication rates. The rare, but possible post-procedure complications such as recurrent CSP and enhanced myometrial vascularity are also mentioned.
Collapse
Affiliation(s)
| | - Andrea Kaelin Agten
- Liverpool Women's Hospital NHS Foundation Trust, Liverpool, L8 7SS, United Kingdom
| | - Ana Monteagudo
- Icahn School of Medicine. Carnegie Maternal Fetal Associates New York, USA
| | - Giuseppe Calỉ
- Maternal Fetal Medicine Unit AO Villa Sofia-Cervello, Italy
| | | |
Collapse
|
4
|
Cetin F, Kayar İ, Serin AN, Birge Ö. Efficacy of suction curettage as the first-line treatment of cesarean scar pregnancy: A retrospective study. J Gynecol Obstet Hum Reprod 2023; 52:102531. [PMID: 36592889 DOI: 10.1016/j.jogoh.2022.102531] [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: 11/07/2022] [Revised: 12/03/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE There is still no consensus on a safe and efficient treatment modality for cesarean scar pregnancy (CSP), which is known to cause severe complications, such as life-threatening hemorrhage. Suction curettage (SC) has been used as the first-line treatment for CSP with controversial outcomes. In this context, the objective of this study is to analyze the efficacy of SC in the treatment of CSP. METHODS The sample of this retrospective study consisted of 64 CSP patients treated using SC between 2012 and 2022. Patients' demographic and clinical variables, including the thickness of the myometrium at the lower uterine segment between the urinary bladder and cesarean scar, were obtained from their medical records. The study's primary outcome was determined as the success rate of SC. Accordingly, the patients were categorized into two groups: successful SC (Group 1) and unsuccessful SC (Group 2). RESULTS The success rate of SC was determined as 78.1%. The number of previous cesarean deliveries, gestational age, baseline beta-human chorionic gonadotropin (β-hCG) values, and endometrial thickness was significantly higher in Group 2 (p<0.05 for all), whereas the fetal cardiac activity and absence of an embryonic pole were significantly higher in Group 2 (p = 0.001 and p = 0.004, respectively). There was no significant difference between the groups in the thickness of the myometrium at the lower uterine segment (p = 0.890). The hemoglobin levels decreased significantly after SC in both Groups 1 and 2 (p<0.001 and p = 0.009, respectively). There was no significant difference between the groups in preoperative and postoperative hemoglobin values and the decrease in hemoglobin levels (p>0.05). CONCLUSION The study findings did not indicate any significant correlation between myometrial thickness at the lower uterine segment and the efficacy of SC in CSP patients. On the other hand, the number of cesarean deliveries, gestational age, baseline β-hCG values, endometrium thickness, fetal cardiac activity, and embryonic pole may be used to predict the outcome of SC in the treatment of CSP.
Collapse
Affiliation(s)
- Ferhat Cetin
- Department of Gynecology and Obstetrics, Osmaniye Private Park Hospital, Osmaniye, Turkey
| | - İlkan Kayar
- Department of Gynecology and Obstetrics, Osmaniye State Hospital, Osmaniye, Turkey.
| | - Aliye Nigar Serin
- Department of Gynecology and Obstetrics, Faculty of Medicine, Karamanoglu Mehmetbey University, Karaman, Turkey
| | - Özer Birge
- Department of Gynecology and Obstetrics, Ordu Training and Research Hospital, Ordu, Turkey
| |
Collapse
|
5
|
Management of caesarean scar pregnancy with ultrasound guided suction curettage followed by foley balloon catheter placement. J Gynecol Obstet Hum Reprod 2022; 51:102471. [DOI: 10.1016/j.jogoh.2022.102471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 11/20/2022]
|
6
|
Qu W, Li H, Zhang T, Zhang Y, Ban Y, Li N, Jiang J, Xie J, Shi W, Hao Y, Li R, Liu W, Cui B. Comparison of different treatment strategies in the management of endogenic caesarean scar pregnancy: a multicentre retrospective study. BMC Pregnancy Childbirth 2022; 22:404. [PMID: 35549886 PMCID: PMC9103451 DOI: 10.1186/s12884-022-04633-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 03/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this study was to evaluate the effectiveness and safety of different treatment strategies for endogenic caesarean scar pregnancy (CSP) patients. Methods According to Vial’s standard, we defined endogenic-type CSP as (1) the gestational sac growing towards the uterine cavity and (2) a greater than 0.3 cm thickness of myometrial tissue at the caesarean scar. A total of 447 endogenic CSP patients out of 527 patients from 4 medical centres in China were enrolled in this study. A total of 120 patients were treated with methotrexate (MTX) followed by surgery, 106 received ultrasound-guided curettage directly and 221 received curettage combined with hysteroscopy. The clinical information and clinical outcomes of these patients were reviewed. Successful treatment was defined as (1) no additional treatment needed, (2) no retained mass of conception and (3) serum β subunit of human chorionic gonadotropin (β-hCG) level returning to a normal level within 4 weeks. The success rate was analysed based on these factors. Result Among 447 patients, no significant difference was observed in baseline characteristics between groups except for foetal heartbeat. The success rate was significantly different (p<0.001) among the three groups. The highest success rate of 95.9% was noted in the hysteroscopy group, and the lowest success rate of 84.0% was noted in the curettage group. In addition, the MTX group reported the longest hospital stay and highest expenses, but the curettage group showed the shortest and lowest expenses, respectively. Nevertheless, no difference in blood loss was observed between the groups. Conclusion The combination of curettage and hysteroscopy represents the most effective strategy. Pretreatment with MTX did not result in better clinical outcomes. Ultrasound-guided curettage directly should not be considered a first-line treatment choice for endogenic CSP patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04633-y.
Collapse
Affiliation(s)
- Wenjie Qu
- Department of Gynaecology and Obstetrics, Qilu Hospital of Shandong University, No.107 Wenhua West Road, Jinan, Jinan, 250012, China
| | - Hua Li
- Department of Gynaecology and Obstetrics, Taian Central Hospital, No.29 Longtan Road Taishan District, Tai'an City, Jinan, 250012, China
| | - Teng Zhang
- Department of Gynaecology and Obstetrics, Qilu Hospital of Shandong University, No.107 Wenhua West Road, Jinan, Jinan, 250012, China
| | - Yuan Zhang
- Department of Gynaecology and Obstetrics, Qilu Hospital of Shandong University, No.107 Wenhua West Road, Jinan, Jinan, 250012, China
| | - Yanli Ban
- Department of Gynaecology and Obstetrics, Qilu Hospital of Shandong University, No.107 Wenhua West Road, Jinan, Jinan, 250012, China
| | - Ningfeng Li
- Department of Gynaecology and Obstetrics, Qilu Hospital of Shandong University, No.107 Wenhua West Road, Jinan, Jinan, 250012, China.,Cheeloo College of Medicine, Shandong University, No.44 Wenhua West Road, Jinan, Jinan, 250012, China
| | - Jingyan Jiang
- Department of Obstetrics and Gynaecology, Jinan Central Hospital, No.105 Jiefang Road, Jinan, Jinan, 250012, China
| | - Juan Xie
- Department of Gynaecology and Obstetrics, Taian Central Hospital, No.29 Longtan Road Taishan District, Tai'an City, Jinan, 250012, China
| | - Wentian Shi
- Obstetrics and Gynaecology Department, Liaocheng People's Hospital, NO.67 Dongchang West Road, Liaocheng City Jinan, 250012, China
| | - Yiping Hao
- Department of Gynaecology and Obstetrics, Qilu Hospital of Shandong University, No.107 Wenhua West Road, Jinan, Jinan, 250012, China.,Cheeloo College of Medicine, Shandong University, No.44 Wenhua West Road, Jinan, Jinan, 250012, China
| | - Ruowen Li
- Department of Gynaecology and Obstetrics, Qilu Hospital of Shandong University, No.107 Wenhua West Road, Jinan, Jinan, 250012, China.,Cheeloo College of Medicine, Shandong University, No.44 Wenhua West Road, Jinan, Jinan, 250012, China
| | - Wei Liu
- Obstetrics and Gynaecology Department, Liaocheng People's Hospital, NO.67 Dongchang West Road, Liaocheng City Jinan, 250012, China.
| | - Baoxia Cui
- Department of Gynaecology and Obstetrics, Qilu Hospital of Shandong University, No.107 Wenhua West Road, Jinan, Jinan, 250012, China.
| |
Collapse
|
7
|
Hong T, Chai Z, Liu M, Zheng L, Qi F. The Efficacy and Health Economics of Different Treatments for Type 1 Cesarean Scar Pregnancy. Front Pharmacol 2022; 13:822319. [PMID: 35153794 PMCID: PMC8831712 DOI: 10.3389/fphar.2022.822319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/12/2022] [Indexed: 02/03/2023] Open
Abstract
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.
Collapse
|
8
|
Uterine Artery Embolization Combined with Subsequent Suction Evacuation as Low-Risk Treatment for Cesarean Scar Pregnancy. Diagnostics (Basel) 2021; 11:diagnostics11122350. [PMID: 34943587 PMCID: PMC8700670 DOI: 10.3390/diagnostics11122350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/25/2021] [Accepted: 12/07/2021] [Indexed: 11/26/2022] Open
Abstract
Objective: The aim of this study is to propose a standardized management of care for patients diagnosed with cesarean scar pregnancy (CSP). There are two types of CSP: Type 1 (on the scar) vs. type 2 (in the niche). To date there is no international standard to predict the extent of invasion or the optimal management of CSP. Materials and methods: We used intramuscular methotrexate injection followed by uterine artery embolization combined with suction evacuation as a conservative approach for the treatment of seven patients diagnosed with CSP. Our inclusion criteria, to be satisfied simultaneously, were established as follows: (1) patients with CSP; (2) early gestational age ≤ 9 weeks, and (3) written consent of the proposed treatment of the patient. Results: This course of treatment produced a positive outcome in all cases. We did not have any complications (e.g., emergency hysterectomy, perforation of the uterine cavity, severe hemorrhage, or endometritis) during the procedures or in the follow-up. The most important predictors of successful management are early diagnosis of CSP and orientation of the invasive trophoblast opposite to the scar. Conclusions: The main finding from this series of cases is that associating systemic methotrexate and uterine artery embolization provides efficient and low-risk management of CSP. This treatment regime is adequate for both types of CSPs. We consider that early localization diagnosis of pregnancy following a cesarean delivery is mandatory for CSP morbidity prevention.
Collapse
|
9
|
OuYang Z, Wu J, Wan Z. Is suction curettage an effective treatment alternative for cesarean scar pregnancies? Letter to the Editor. Eur J Obstet Gynecol Reprod Biol 2021; 260:233-234. [PMID: 33766482 DOI: 10.1016/j.ejogrb.2021.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/08/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Zhenbo OuYang
- Department of Gynecology, Guangdong Second Provincial General Hospital, Guangzhou, China.
| | - Jiawen Wu
- Department of Gynecology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Zixian Wan
- Department of Gynecology, Guangdong Second Provincial General Hospital, Guangzhou, China
| |
Collapse
|