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Rodgers SK, Horrow MM, Doubilet PM, Frates MC, Kennedy A, Andreotti R, Brandi K, Detti L, Horvath SK, Kamaya A, Koyama A, Lema PC, Maturen KE, Morgan T, Običan SG, Olinger K, Sohaey R, Senapati S, Strachowski LM. A Lexicon for First-Trimester US: Society of Radiologists in Ultrasound Consensus Conference Recommendations. Am J Obstet Gynecol 2024:S0002-9378(24)00811-1. [PMID: 39198135 DOI: 10.1016/j.ajog.2024.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/09/2024] [Accepted: 06/14/2024] [Indexed: 09/01/2024]
Abstract
The Society of Radiologists in Ultrasound convened a multisociety panel to develop a first-trimester US lexicon based on scientific evidence, societal guidelines, and expert consensus that would be appropriate for imagers, clinicians, and patients. Through a modified Delphi process with consensus of at least 80%, agreement was reached for preferred terms, synonyms, and terms to avoid. An intrauterine pregnancy (IUP) is defined as a pregnancy implanted in a normal location within the uterus. In contrast, an ectopic pregnancy (EP) is any pregnancy implanted in an abnormal location, whether extrauterine or intrauterine, thus categorizing cesarean scar implantations as EPs. The term pregnancy of unknown location is used in the setting of a pregnant patient without evidence of a definite or probable IUP or EP at transvaginal US. Since cardiac development is a gradual process and cardiac chambers are not fully formed in the first trimester, the term cardiac activity is recommended in lieu of 'heart motion' or 'heartbeat.' The terms 'living' and 'viable' should also be avoided in the first trimester. 'Pregnancy failure' is replaced by early pregnancy loss (EPL). When paired with various modifiers, EPL is used to describe a pregnancy in the first trimester that may or will not progress, is in the process of expulsion, or has either incompletely or completely passed.
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Affiliation(s)
- Shuchi K Rodgers
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pa
| | - Mindy M Horrow
- Department of Radiology, Einstein Healthcare Network/Jefferson Health, Philadelphia, Pa
| | - Peter M Doubilet
- Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass
| | - Mary C Frates
- Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass
| | - Anne Kennedy
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Rochelle Andreotti
- Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tenn
| | - Kristyn Brandi
- American College of Obstetricians and Gynecologists, Newark, NJ
| | - Laura Detti
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Tex
| | - Sarah K Horvath
- Department of Obstetrics and Gynecology, Pennsylvania State University, University Park, Pa
| | - Aya Kamaya
- Department of Radiology, Stanford University, Stanford, Calif
| | - Atsuko Koyama
- Division of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Ariz
| | | | - Katherine E Maturen
- Department of Radiology and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich
| | - Tara Morgan
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz
| | - Sarah G Običan
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, Fla
| | - Kristen Olinger
- Department of Radiology, University of North Carolina, Chapel Hill, NC
| | - Roya Sohaey
- Department of Diagnostic Radiology, Oregon Health & Sciences University, Portland, Ore
| | - Suneeta Senapati
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pa
| | - Lori M Strachowski
- Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110.
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Rodgers SK, Horrow MM, Doubilet PM, Frates MC, Kennedy A, Andreotti R, Brandi K, Detti L, Horvath SK, Kamaya A, Koyama A, Lema PC, Maturen KE, Morgan T, Običan SG, Olinger K, Sohaey R, Senapati S, Strachowski LM. A Lexicon for First-Trimester US: Society of Radiologists in Ultrasound Consensus Conference Recommendations. Radiology 2024; 312:e240122. [PMID: 39189906 DOI: 10.1148/radiol.240122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
The Society of Radiologists in Ultrasound convened a multisociety panel to develop a first-trimester US lexicon based on scientific evidence, societal guidelines, and expert consensus that would be appropriate for imagers, clinicians, and patients. Through a modified Delphi process with consensus of at least 80%, agreement was reached for preferred terms, synonyms, and terms to avoid. An intrauterine pregnancy (IUP) is defined as a pregnancy implanted in a normal location within the uterus. In contrast, an ectopic pregnancy (EP) is any pregnancy implanted in an abnormal location, whether extrauterine or intrauterine, thus categorizing cesarean scar implantations as EPs. The term pregnancy of unknown location is used in the setting of a pregnant patient without evidence of a definite or probable IUP or EP at transvaginal US. Since cardiac development is a gradual process and cardiac chambers are not fully formed in the first trimester, the term cardiac activity is recommended in lieu of 'heart motion' or 'heartbeat.' The terms 'living' and 'viable' should also be avoided in the first trimester. 'Pregnancy failure' is replaced by early pregnancy loss (EPL). When paired with various modifiers, EPL is used to describe a pregnancy in the first trimester that may or will not progress, is in the process of expulsion, or has either incompletely or completely passed. © RSNA and Elsevier, 2024 Supplemental material is available for this article. This article is a simultaneous joint publication in Radiology and American Journal of Obstetrics & Gynecology. All rights reserved. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Either version may be used in citing this article. See also the editorial by Scoutt and Norton in this issue.
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Affiliation(s)
- Shuchi K Rodgers
- From the Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (S.K.R.); Department of Radiology, Einstein Healthcare Network/Jefferson Health, Philadelphia, Pa (M.M.H.); Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass (P.M.D., M.C.F.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A. Kennedy); Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tenn (R.A.); American College of Obstetricians and Gynecologists, Newark, NJ (K.B.); Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Tex (L.D.); Department of Obstetrics and Gynecology, Pennsylvania State University, University Park, Pa (S.K.H.); Department of Radiology, Stanford University, Stanford, Calif (A. Kamaya); Division of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Ariz (A. Koyama); Department of Emergency Medicine, Columbia University, New York, NY (P.C.L.); Department of Radiology and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (T.M.); Department of Obstetrics and Gynecology, University of South Florida, Tampa, Fla (S.G.O.); Department of Radiology, University of North Carolina, Chapel Hill, NC (K.O.); Department of Diagnostic Radiology, Oregon Health & Sciences University, Portland, Ore (R.S.); Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pa (S.S.); and Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.)
| | - Mindy M Horrow
- From the Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (S.K.R.); Department of Radiology, Einstein Healthcare Network/Jefferson Health, Philadelphia, Pa (M.M.H.); Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass (P.M.D., M.C.F.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A. Kennedy); Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tenn (R.A.); American College of Obstetricians and Gynecologists, Newark, NJ (K.B.); Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Tex (L.D.); Department of Obstetrics and Gynecology, Pennsylvania State University, University Park, Pa (S.K.H.); Department of Radiology, Stanford University, Stanford, Calif (A. Kamaya); Division of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Ariz (A. Koyama); Department of Emergency Medicine, Columbia University, New York, NY (P.C.L.); Department of Radiology and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (T.M.); Department of Obstetrics and Gynecology, University of South Florida, Tampa, Fla (S.G.O.); Department of Radiology, University of North Carolina, Chapel Hill, NC (K.O.); Department of Diagnostic Radiology, Oregon Health & Sciences University, Portland, Ore (R.S.); Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pa (S.S.); and Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.)
| | - Peter M Doubilet
- From the Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (S.K.R.); Department of Radiology, Einstein Healthcare Network/Jefferson Health, Philadelphia, Pa (M.M.H.); Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass (P.M.D., M.C.F.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A. Kennedy); Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tenn (R.A.); American College of Obstetricians and Gynecologists, Newark, NJ (K.B.); Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Tex (L.D.); Department of Obstetrics and Gynecology, Pennsylvania State University, University Park, Pa (S.K.H.); Department of Radiology, Stanford University, Stanford, Calif (A. Kamaya); Division of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Ariz (A. Koyama); Department of Emergency Medicine, Columbia University, New York, NY (P.C.L.); Department of Radiology and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (T.M.); Department of Obstetrics and Gynecology, University of South Florida, Tampa, Fla (S.G.O.); Department of Radiology, University of North Carolina, Chapel Hill, NC (K.O.); Department of Diagnostic Radiology, Oregon Health & Sciences University, Portland, Ore (R.S.); Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pa (S.S.); and Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.)
| | - Mary C Frates
- From the Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (S.K.R.); Department of Radiology, Einstein Healthcare Network/Jefferson Health, Philadelphia, Pa (M.M.H.); Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass (P.M.D., M.C.F.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A. Kennedy); Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tenn (R.A.); American College of Obstetricians and Gynecologists, Newark, NJ (K.B.); Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Tex (L.D.); Department of Obstetrics and Gynecology, Pennsylvania State University, University Park, Pa (S.K.H.); Department of Radiology, Stanford University, Stanford, Calif (A. Kamaya); Division of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Ariz (A. Koyama); Department of Emergency Medicine, Columbia University, New York, NY (P.C.L.); Department of Radiology and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (T.M.); Department of Obstetrics and Gynecology, University of South Florida, Tampa, Fla (S.G.O.); Department of Radiology, University of North Carolina, Chapel Hill, NC (K.O.); Department of Diagnostic Radiology, Oregon Health & Sciences University, Portland, Ore (R.S.); Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pa (S.S.); and Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.)
| | - Anne Kennedy
- From the Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (S.K.R.); Department of Radiology, Einstein Healthcare Network/Jefferson Health, Philadelphia, Pa (M.M.H.); Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass (P.M.D., M.C.F.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A. Kennedy); Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tenn (R.A.); American College of Obstetricians and Gynecologists, Newark, NJ (K.B.); Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Tex (L.D.); Department of Obstetrics and Gynecology, Pennsylvania State University, University Park, Pa (S.K.H.); Department of Radiology, Stanford University, Stanford, Calif (A. Kamaya); Division of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Ariz (A. Koyama); Department of Emergency Medicine, Columbia University, New York, NY (P.C.L.); Department of Radiology and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (T.M.); Department of Obstetrics and Gynecology, University of South Florida, Tampa, Fla (S.G.O.); Department of Radiology, University of North Carolina, Chapel Hill, NC (K.O.); Department of Diagnostic Radiology, Oregon Health & Sciences University, Portland, Ore (R.S.); Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pa (S.S.); and Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.)
| | - Rochelle Andreotti
- From the Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (S.K.R.); Department of Radiology, Einstein Healthcare Network/Jefferson Health, Philadelphia, Pa (M.M.H.); Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass (P.M.D., M.C.F.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A. Kennedy); Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tenn (R.A.); American College of Obstetricians and Gynecologists, Newark, NJ (K.B.); Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Tex (L.D.); Department of Obstetrics and Gynecology, Pennsylvania State University, University Park, Pa (S.K.H.); Department of Radiology, Stanford University, Stanford, Calif (A. Kamaya); Division of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Ariz (A. Koyama); Department of Emergency Medicine, Columbia University, New York, NY (P.C.L.); Department of Radiology and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (T.M.); Department of Obstetrics and Gynecology, University of South Florida, Tampa, Fla (S.G.O.); Department of Radiology, University of North Carolina, Chapel Hill, NC (K.O.); Department of Diagnostic Radiology, Oregon Health & Sciences University, Portland, Ore (R.S.); Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pa (S.S.); and Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.)
| | - Kristyn Brandi
- From the Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (S.K.R.); Department of Radiology, Einstein Healthcare Network/Jefferson Health, Philadelphia, Pa (M.M.H.); Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass (P.M.D., M.C.F.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A. Kennedy); Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tenn (R.A.); American College of Obstetricians and Gynecologists, Newark, NJ (K.B.); Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Tex (L.D.); Department of Obstetrics and Gynecology, Pennsylvania State University, University Park, Pa (S.K.H.); Department of Radiology, Stanford University, Stanford, Calif (A. Kamaya); Division of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Ariz (A. Koyama); Department of Emergency Medicine, Columbia University, New York, NY (P.C.L.); Department of Radiology and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (T.M.); Department of Obstetrics and Gynecology, University of South Florida, Tampa, Fla (S.G.O.); Department of Radiology, University of North Carolina, Chapel Hill, NC (K.O.); Department of Diagnostic Radiology, Oregon Health & Sciences University, Portland, Ore (R.S.); Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pa (S.S.); and Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.)
| | - Laura Detti
- From the Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (S.K.R.); Department of Radiology, Einstein Healthcare Network/Jefferson Health, Philadelphia, Pa (M.M.H.); Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass (P.M.D., M.C.F.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A. Kennedy); Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tenn (R.A.); American College of Obstetricians and Gynecologists, Newark, NJ (K.B.); Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Tex (L.D.); Department of Obstetrics and Gynecology, Pennsylvania State University, University Park, Pa (S.K.H.); Department of Radiology, Stanford University, Stanford, Calif (A. Kamaya); Division of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Ariz (A. Koyama); Department of Emergency Medicine, Columbia University, New York, NY (P.C.L.); Department of Radiology and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (T.M.); Department of Obstetrics and Gynecology, University of South Florida, Tampa, Fla (S.G.O.); Department of Radiology, University of North Carolina, Chapel Hill, NC (K.O.); Department of Diagnostic Radiology, Oregon Health & Sciences University, Portland, Ore (R.S.); Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pa (S.S.); and Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.)
| | - Sarah K Horvath
- From the Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (S.K.R.); Department of Radiology, Einstein Healthcare Network/Jefferson Health, Philadelphia, Pa (M.M.H.); Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass (P.M.D., M.C.F.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A. Kennedy); Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tenn (R.A.); American College of Obstetricians and Gynecologists, Newark, NJ (K.B.); Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Tex (L.D.); Department of Obstetrics and Gynecology, Pennsylvania State University, University Park, Pa (S.K.H.); Department of Radiology, Stanford University, Stanford, Calif (A. Kamaya); Division of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Ariz (A. Koyama); Department of Emergency Medicine, Columbia University, New York, NY (P.C.L.); Department of Radiology and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (T.M.); Department of Obstetrics and Gynecology, University of South Florida, Tampa, Fla (S.G.O.); Department of Radiology, University of North Carolina, Chapel Hill, NC (K.O.); Department of Diagnostic Radiology, Oregon Health & Sciences University, Portland, Ore (R.S.); Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pa (S.S.); and Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.)
| | - Aya Kamaya
- From the Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (S.K.R.); Department of Radiology, Einstein Healthcare Network/Jefferson Health, Philadelphia, Pa (M.M.H.); Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass (P.M.D., M.C.F.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A. Kennedy); Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tenn (R.A.); American College of Obstetricians and Gynecologists, Newark, NJ (K.B.); Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Tex (L.D.); Department of Obstetrics and Gynecology, Pennsylvania State University, University Park, Pa (S.K.H.); Department of Radiology, Stanford University, Stanford, Calif (A. Kamaya); Division of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Ariz (A. Koyama); Department of Emergency Medicine, Columbia University, New York, NY (P.C.L.); Department of Radiology and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (T.M.); Department of Obstetrics and Gynecology, University of South Florida, Tampa, Fla (S.G.O.); Department of Radiology, University of North Carolina, Chapel Hill, NC (K.O.); Department of Diagnostic Radiology, Oregon Health & Sciences University, Portland, Ore (R.S.); Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pa (S.S.); and Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.)
| | - Atsuko Koyama
- From the Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (S.K.R.); Department of Radiology, Einstein Healthcare Network/Jefferson Health, Philadelphia, Pa (M.M.H.); Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass (P.M.D., M.C.F.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A. Kennedy); Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tenn (R.A.); American College of Obstetricians and Gynecologists, Newark, NJ (K.B.); Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Tex (L.D.); Department of Obstetrics and Gynecology, Pennsylvania State University, University Park, Pa (S.K.H.); Department of Radiology, Stanford University, Stanford, Calif (A. Kamaya); Division of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Ariz (A. Koyama); Department of Emergency Medicine, Columbia University, New York, NY (P.C.L.); Department of Radiology and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (T.M.); Department of Obstetrics and Gynecology, University of South Florida, Tampa, Fla (S.G.O.); Department of Radiology, University of North Carolina, Chapel Hill, NC (K.O.); Department of Diagnostic Radiology, Oregon Health & Sciences University, Portland, Ore (R.S.); Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pa (S.S.); and Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.)
| | - Penelope Chun Lema
- From the Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (S.K.R.); Department of Radiology, Einstein Healthcare Network/Jefferson Health, Philadelphia, Pa (M.M.H.); Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass (P.M.D., M.C.F.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A. Kennedy); Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tenn (R.A.); American College of Obstetricians and Gynecologists, Newark, NJ (K.B.); Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Tex (L.D.); Department of Obstetrics and Gynecology, Pennsylvania State University, University Park, Pa (S.K.H.); Department of Radiology, Stanford University, Stanford, Calif (A. Kamaya); Division of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Ariz (A. Koyama); Department of Emergency Medicine, Columbia University, New York, NY (P.C.L.); Department of Radiology and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (T.M.); Department of Obstetrics and Gynecology, University of South Florida, Tampa, Fla (S.G.O.); Department of Radiology, University of North Carolina, Chapel Hill, NC (K.O.); Department of Diagnostic Radiology, Oregon Health & Sciences University, Portland, Ore (R.S.); Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pa (S.S.); and Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.)
| | - Katherine E Maturen
- From the Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (S.K.R.); Department of Radiology, Einstein Healthcare Network/Jefferson Health, Philadelphia, Pa (M.M.H.); Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass (P.M.D., M.C.F.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A. Kennedy); Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tenn (R.A.); American College of Obstetricians and Gynecologists, Newark, NJ (K.B.); Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Tex (L.D.); Department of Obstetrics and Gynecology, Pennsylvania State University, University Park, Pa (S.K.H.); Department of Radiology, Stanford University, Stanford, Calif (A. Kamaya); Division of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Ariz (A. Koyama); Department of Emergency Medicine, Columbia University, New York, NY (P.C.L.); Department of Radiology and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (T.M.); Department of Obstetrics and Gynecology, University of South Florida, Tampa, Fla (S.G.O.); Department of Radiology, University of North Carolina, Chapel Hill, NC (K.O.); Department of Diagnostic Radiology, Oregon Health & Sciences University, Portland, Ore (R.S.); Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pa (S.S.); and Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.)
| | - Tara Morgan
- From the Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (S.K.R.); Department of Radiology, Einstein Healthcare Network/Jefferson Health, Philadelphia, Pa (M.M.H.); Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass (P.M.D., M.C.F.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A. Kennedy); Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tenn (R.A.); American College of Obstetricians and Gynecologists, Newark, NJ (K.B.); Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Tex (L.D.); Department of Obstetrics and Gynecology, Pennsylvania State University, University Park, Pa (S.K.H.); Department of Radiology, Stanford University, Stanford, Calif (A. Kamaya); Division of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Ariz (A. Koyama); Department of Emergency Medicine, Columbia University, New York, NY (P.C.L.); Department of Radiology and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (T.M.); Department of Obstetrics and Gynecology, University of South Florida, Tampa, Fla (S.G.O.); Department of Radiology, University of North Carolina, Chapel Hill, NC (K.O.); Department of Diagnostic Radiology, Oregon Health & Sciences University, Portland, Ore (R.S.); Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pa (S.S.); and Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.)
| | - Sarah G Običan
- From the Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (S.K.R.); Department of Radiology, Einstein Healthcare Network/Jefferson Health, Philadelphia, Pa (M.M.H.); Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass (P.M.D., M.C.F.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A. Kennedy); Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tenn (R.A.); American College of Obstetricians and Gynecologists, Newark, NJ (K.B.); Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Tex (L.D.); Department of Obstetrics and Gynecology, Pennsylvania State University, University Park, Pa (S.K.H.); Department of Radiology, Stanford University, Stanford, Calif (A. Kamaya); Division of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Ariz (A. Koyama); Department of Emergency Medicine, Columbia University, New York, NY (P.C.L.); Department of Radiology and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (T.M.); Department of Obstetrics and Gynecology, University of South Florida, Tampa, Fla (S.G.O.); Department of Radiology, University of North Carolina, Chapel Hill, NC (K.O.); Department of Diagnostic Radiology, Oregon Health & Sciences University, Portland, Ore (R.S.); Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pa (S.S.); and Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.)
| | - Kristen Olinger
- From the Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (S.K.R.); Department of Radiology, Einstein Healthcare Network/Jefferson Health, Philadelphia, Pa (M.M.H.); Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass (P.M.D., M.C.F.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A. Kennedy); Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tenn (R.A.); American College of Obstetricians and Gynecologists, Newark, NJ (K.B.); Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Tex (L.D.); Department of Obstetrics and Gynecology, Pennsylvania State University, University Park, Pa (S.K.H.); Department of Radiology, Stanford University, Stanford, Calif (A. Kamaya); Division of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Ariz (A. Koyama); Department of Emergency Medicine, Columbia University, New York, NY (P.C.L.); Department of Radiology and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (T.M.); Department of Obstetrics and Gynecology, University of South Florida, Tampa, Fla (S.G.O.); Department of Radiology, University of North Carolina, Chapel Hill, NC (K.O.); Department of Diagnostic Radiology, Oregon Health & Sciences University, Portland, Ore (R.S.); Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pa (S.S.); and Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.)
| | - Roya Sohaey
- From the Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (S.K.R.); Department of Radiology, Einstein Healthcare Network/Jefferson Health, Philadelphia, Pa (M.M.H.); Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass (P.M.D., M.C.F.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A. Kennedy); Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tenn (R.A.); American College of Obstetricians and Gynecologists, Newark, NJ (K.B.); Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Tex (L.D.); Department of Obstetrics and Gynecology, Pennsylvania State University, University Park, Pa (S.K.H.); Department of Radiology, Stanford University, Stanford, Calif (A. Kamaya); Division of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Ariz (A. Koyama); Department of Emergency Medicine, Columbia University, New York, NY (P.C.L.); Department of Radiology and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (T.M.); Department of Obstetrics and Gynecology, University of South Florida, Tampa, Fla (S.G.O.); Department of Radiology, University of North Carolina, Chapel Hill, NC (K.O.); Department of Diagnostic Radiology, Oregon Health & Sciences University, Portland, Ore (R.S.); Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pa (S.S.); and Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.)
| | - Suneeta Senapati
- From the Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (S.K.R.); Department of Radiology, Einstein Healthcare Network/Jefferson Health, Philadelphia, Pa (M.M.H.); Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass (P.M.D., M.C.F.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A. Kennedy); Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tenn (R.A.); American College of Obstetricians and Gynecologists, Newark, NJ (K.B.); Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Tex (L.D.); Department of Obstetrics and Gynecology, Pennsylvania State University, University Park, Pa (S.K.H.); Department of Radiology, Stanford University, Stanford, Calif (A. Kamaya); Division of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Ariz (A. Koyama); Department of Emergency Medicine, Columbia University, New York, NY (P.C.L.); Department of Radiology and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (T.M.); Department of Obstetrics and Gynecology, University of South Florida, Tampa, Fla (S.G.O.); Department of Radiology, University of North Carolina, Chapel Hill, NC (K.O.); Department of Diagnostic Radiology, Oregon Health & Sciences University, Portland, Ore (R.S.); Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pa (S.S.); and Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.)
| | - Lori M Strachowski
- From the Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (S.K.R.); Department of Radiology, Einstein Healthcare Network/Jefferson Health, Philadelphia, Pa (M.M.H.); Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass (P.M.D., M.C.F.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A. Kennedy); Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tenn (R.A.); American College of Obstetricians and Gynecologists, Newark, NJ (K.B.); Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Tex (L.D.); Department of Obstetrics and Gynecology, Pennsylvania State University, University Park, Pa (S.K.H.); Department of Radiology, Stanford University, Stanford, Calif (A. Kamaya); Division of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Ariz (A. Koyama); Department of Emergency Medicine, Columbia University, New York, NY (P.C.L.); Department of Radiology and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (T.M.); Department of Obstetrics and Gynecology, University of South Florida, Tampa, Fla (S.G.O.); Department of Radiology, University of North Carolina, Chapel Hill, NC (K.O.); Department of Diagnostic Radiology, Oregon Health & Sciences University, Portland, Ore (R.S.); Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pa (S.S.); and Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.)
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Sun H, Wang J, Fu P, Zhou T, Liu R. Systematic evaluation of the efficacy of treatments for cesarean scar pregnancy. Reprod Biol Endocrinol 2024; 22:84. [PMID: 39026328 PMCID: PMC11256510 DOI: 10.1186/s12958-024-01256-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 07/06/2024] [Indexed: 07/20/2024] Open
Abstract
STUDY OBJECTIVE Cesarean scar pregnancy (CSP) is a type of ectopic pregnancy associated with severe complications, including significant hemorrhage, the potential need for hysterectomy, and life-threatening risks. Currently, two classification methods exist for CSP: Vial (type Ia and IIa) and Chinese Expert's Consensus (type Ib, type IIb, and type IIIb). However, these methods have limitations in guiding the selection of appropriate treatment plans for CSP. The purpose of this study was to systematically evaluate the effectiveness of various treatments for CSP within our clinic. METHOD Our study included 906 patients with CSP from January 2013 to December 2018. The chi-squared test and logistic analysis were used to compare the clinical characteristics. The median and interquartile range (IQR) was calculated. We also analyzed whether preoperative application of methotrexate (MTX) could improve surgical outcomes and the relevant characteristics of misdiagnosed CSP patients. RESULTS There was a significant difference in gestational age, gestational sac diameter, gestational sac width, gestational sac area, remnant myometrial thickness, vaginal bleeding and preoperative hemoglobin levels (p < 0.001) but not in the incidence of residual tissue (p = 0.053). The other factors (intraoperative blood loss, hemoglobin decline, first hemoglobin after operation, total hospital stay, hospital stay after operation, transfusion and duration of catheter drain) were significantly different (p < 0.001). For type Ia and type Ib CSP, 39.3% and 40.2% of patients were treated with dilatation and curettage (D&E) under ultrasound, respectively. For type IIa and type IIIb CSP, 29.9% and 62.7% of patients were treated with laparotomy, respectively. There were no differences in surgical methods, residual tissue and reoperation between the MTX and non-MTX groups (p = 0.20), but liver damage, hospital stay and pain perception were more remarkable in the MTX group. It is noteworthy that 14% of the patients were misdiagnosed with an intrauterine pregnancy. The incidence of misdiagnosis in type IIa CSP patients was higher than that in type Ia CSP patients (p < 0.001). CONCLUSION For type I CSP patients, D&E under ultrasound or D&E under hysteroscopy should be recommended. For type IIIb CSP patients, operative resection should be used. It is currently difficult to choose the appropriate treatment methods for type IIa or type IIb CSP patients.
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Affiliation(s)
- Haiying Sun
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Anv. Wuhan, Wuhan, Hubei, 430030, P.R. China
| | - Juan Wang
- Department of Obstetrics and Gynecology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Peiying Fu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Anv. Wuhan, Wuhan, Hubei, 430030, P.R. China
| | - Ting Zhou
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Anv. Wuhan, Wuhan, Hubei, 430030, P.R. China
| | - Ronghua Liu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Anv. Wuhan, Wuhan, Hubei, 430030, P.R. China.
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Lai THT, Ko JKY, Ng HYE. A 20 year experience in the management of non-tubal ectopic pregnancies in a tertiary hospital - a retrospective review. Reprod Health 2024; 21:95. [PMID: 38956582 PMCID: PMC11218395 DOI: 10.1186/s12978-024-01838-6] [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: 02/06/2024] [Accepted: 06/26/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Non-tubal ectopic pregnancies account for < 10% of all ectopic pregnancies. Due to its rarity and wide variation in clinical practice, there is no guideline or consensus for its management. We reported our 20-year experience in the management of non-tubal ectopic pregnancies in a tertiary hospital. METHODS This is a retrospective review of all women admitted for non-tubal ectopic pregnancies from January 2003 to December 2022 in a tertiary hospital. Women with non-tubal ectopic pregnancies diagnosed by ultrasound or operation were included for analysis. RESULTS Within the study period, 180 women were diagnosed to have non-tubal ectopic pregnancies at a mean gestation of 6.8 weeks. 16.7% (30/180) were conceived via assisted reproduction. Medical treatment was the first-line management option for 81 women, of which 75 (92.1%) women received intralesional methotrexate administered under transvaginal ultrasound guidance. The success rate of intralesional methotrexate ranges from 76.5% to 92.3%. Intralesional methotrexate was successful even in cases with a positive fetal pulsation or with high human chorionic gonadotrophin levels up to 252605U/L. Twenty seven women were managed expectantly and 40 underwent surgery. Nine (11.1%), two (6.1%), and one (2.3%) women required surgery due to massive or recurrent bleeding following medical, expectant, or surgical treatment. Hysterotomy and uterine artery embolization were necessary to control bleeding in one Caesarean scar and one cervical pregnancy. CONCLUSIONS Intralesional methotrexate is more effective than systemic methotrexate and should be considered as first line medical treatment for non-tubal ectopic pregnancies. It has a high success rate in the management of unruptured non-tubal ectopic pregnancies even in the presence of fetal pulsations or high human chorionic gonadotrophin levels, but patients may require a prolonged period of monitoring. Close surveillance and readily available surgery were required due to the risk of heavy post-procedural intra-abdominal bleeding.
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Affiliation(s)
- Theodora Hei Tung Lai
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 6/F Professorial Block, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China
| | - Jennifer Ka Yee Ko
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 6/F Professorial Block, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China.
| | - Hung Yu Ernest Ng
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 6/F Professorial Block, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China
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Kennedy A, Debbink M, Griffith A, Kaiser J, Woodward P. Cesarean Scar Ectopic Pregnancy: A Do-Not-Miss Diagnosis. Radiographics 2024; 44:e230199. [PMID: 38843098 DOI: 10.1148/rg.230199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
The rate of cesarean section (CS) for delivery has increased internationally, reaching 50% in some countries. Abnormal implantation of a new pregnancy at the site of the prior hysterotomy is an important complication because of the risks of hemorrhage, uterine rupture, and progression to placenta accreta spectrum (PAS), a condition with high morbidity with potential for catastrophic obstetric hemorrhage, maternal and fetal mortality, and loss of fertility. Cesarean scar ectopic pregnancy (CSEP) is the recommended term to describe these pregnancies, which are recognized on the basis of the sac implantation site, growth pattern, and associated abnormal perfusion. The true incidence of CSEP is unknown because the condition is likely underdiagnosed and underreported. The 2022 Society for Maternal-Fetal Medicine consult series notes that severe maternal morbidity and mortality are linked to difficulty in making the diagnosis of CSEP. The authors review the signs of CSEP at imaging, some pitfalls that may lead to delayed or missed diagnosis, and the consequences thereof. CSEPs must be differentiated from low implantation of a normal pregnancy, cervical ectopic pregnancy, and evolving pregnancy loss. Early recognition allows prompt and safe treatment that is usually surgical. Early treatment results in decreased health care costs, a shorter hospital stay, preservation of fertility, and prevention of iatrogenic preterm delivery, which is typical in cases that progress to PAS. Hysterectomy has serious negative psychologic consequences for patients of childbearing age; early diagnosis and prompt treatment of CSEP can prevent this often-ignored complication. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Anne Kennedy
- From the Departments of Radiology and Imaging Sciences (A.K., A.G., P.W.) and Obstetrics and Gynecology (M.D., J.K.), University of Utah Hospital, 30 N Medical Dr, Salt Lake City, UT 84132
| | - Michelle Debbink
- From the Departments of Radiology and Imaging Sciences (A.K., A.G., P.W.) and Obstetrics and Gynecology (M.D., J.K.), University of Utah Hospital, 30 N Medical Dr, Salt Lake City, UT 84132
| | - April Griffith
- From the Departments of Radiology and Imaging Sciences (A.K., A.G., P.W.) and Obstetrics and Gynecology (M.D., J.K.), University of Utah Hospital, 30 N Medical Dr, Salt Lake City, UT 84132
| | - Jennifer Kaiser
- From the Departments of Radiology and Imaging Sciences (A.K., A.G., P.W.) and Obstetrics and Gynecology (M.D., J.K.), University of Utah Hospital, 30 N Medical Dr, Salt Lake City, UT 84132
| | - Paula Woodward
- From the Departments of Radiology and Imaging Sciences (A.K., A.G., P.W.) and Obstetrics and Gynecology (M.D., J.K.), University of Utah Hospital, 30 N Medical Dr, Salt Lake City, UT 84132
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Timor-Tritsch IE, Monteagudo A, Goldstein SR. Early first-trimester transvaginal ultrasound screening for cesarean scar pregnancy in patients with previous cesarean delivery: analysis of the evidence. Am J Obstet Gynecol 2024:S0002-9378(24)00732-4. [PMID: 38955324 DOI: 10.1016/j.ajog.2024.06.041] [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: 08/20/2023] [Revised: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 07/04/2024]
Abstract
Obstetric hemorrhage is a leading cause of maternal morbidity and mortality. An important etiology of obstetric hemorrhage is placenta accreta spectrum. In the last 2 decades, there has been increased clinical experience of the devastating effect of undiagnosed, as well as late diagnosed, cases of cesarean scar pregnancy. There is a growing body of evidence suggesting that cesarean scar pregnancy is an early precursor of second- and third-trimester placenta accreta spectrum. As such, cesarean scar pregnancy should be diagnosed in the early first trimester. This early diagnosis could be achieved by introducing regimented sonographic screening in pregnancies of patients with previous cesarean delivery. This opinion article evaluates the scientific and clinical basis of whether cesarean scar pregnancy, with special focus on its early first-trimester discovery, complies with the accepted requirements of a screening test. Each of the 10 classical screening criteria of Wilson and Jungner were systematically applied to evaluate if the criteria were met by cesarean scar pregnancy, to analyze if it is possible and realistic to carry out screening in a population-wide fashion.
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Affiliation(s)
- Ilan E Timor-Tritsch
- Department of Obstetrics and Gynecology, Hackensack Meridian School of Medicine, Nutley, NJ.
| | - Ana Monteagudo
- Department of Obstetrics and Gynecology, Icahn School of Medicine, New York, NY
| | - Steven R Goldstein
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY
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Debras E, Capmas P, Maudot C, Chavatte-Palmer P. Uterine wound healing after caesarean section: A systematic review. Eur J Obstet Gynecol Reprod Biol 2024; 296:83-90. [PMID: 38417279 DOI: 10.1016/j.ejogrb.2024.02.045] [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: 07/14/2023] [Revised: 12/15/2023] [Accepted: 02/22/2024] [Indexed: 03/01/2024]
Abstract
The rate of caesarean section (CS) is increasing worldwide. Defects in uterine healing have a major gynaecological and obstetric impact (uterine rupture, caesarean scar defect, caesarean scar pregnancy, placenta accreta spectrum). The complex process of cellular uterine healing after surgery, and specifically after CS, remains poorly understood in contrast to skin wound healing. This literature review on uterine wound healing was mainly based on histological observations, particularly after CS. The primary objective of the review was to examine the effects of CS on uterine tissue at the cellular level, based on histological observations. The secondary objectives were to describe the biomechanical characteristics and the therapies used to improve scar tissue after CS. This review was performed using PRISMA criteria, and PubMed was the data source. The study included all clinical and animal model studies with CS and histological analysis of the uterine scar area (macroscopic, microscopic, immunohistochemical and biomechanical). Twenty studies were included: 10 human and 10 animal models. In total, 533 female humans and 511 female animals were included. Review articles, meeting abstracts, case series, case reports, and abstracts without access to full-text were excluded. The search was limited to studies published in English. No correlation was found between cutaneous and uterine healing. The histology of uterine scars is characterized by disorganized smooth muscle, fibrosis with collagen fibres and fewer endometrial glands. As for skin healing, the initial inflammation phase and mediation of some growth factors (particularly connective tissue growth factor, vascular endothelial growth factor, platelet-derived growth factor, tumour necrosis factor α and tumour necrosis factor β) seem to be essential. This initial phase has an impact on the subsequent phases of proliferation and maturation. Collagen appears to play a key role in the initial granulation tissue to replace the loss of substance. Subsequent maturation of the scar tissue is essential, with a decrease in collagen and smooth muscle restoration. Unlike skin, the glandular structure of uterine tissue could be responsible for the relatively high incidence of healing defects. Uterine scar defects after CS are characterized by an atrophic disorganized endometrium with atypia and a fibroblastic highly collagenic stromal reaction. Concerning immunohistochemistry, one study found a decrease in tumour necrosis factor β in uterine scar defects. No correlation was found between biomechanical characteristics (particularly uterine strength) and the presence of a collagenous scar after CS. Based on the findings of this review, an illustration of current understanding about uterine healing is provided. There is currently no validated prevention of caesarean scar defects. Various treatments to improve uterine healing after CS have been tested, and appeared to have good efficacy in animal studies: alpha lipoic acid, growth factors, collagen scaffolds and mesenchymal stem cells. Further prospective studies are needed.
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Affiliation(s)
- E Debras
- AP-HP, GHU-Sud, Hospital Bicêtre, Department of Gynecology and Obstetrics, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; University Paris-Saclay, AP-HP, UVSQ, INRAE, BREED, 78350 Jouy-en-Josas, France; Faculty of medicine, University Paris-Sud Saclay, 63 rue Gabriel Péri, 94270 Le Kremlin Bicêtre, France.
| | - P Capmas
- AP-HP, GHU-Sud, Hospital Bicêtre, Department of Gynecology and Obstetrics, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; Faculty of medicine, University Paris-Sud Saclay, 63 rue Gabriel Péri, 94270 Le Kremlin Bicêtre, France; INSERM - UMR1018 - CESP - Hopital Paul Brousse, 12 avenue Paul Vaillant Couturier, 94800 Villejuif, France
| | - C Maudot
- AP-HP, GHU-Sud, Hospital Bicêtre, Department of Gynecology and Obstetrics, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; University Paris-Saclay, AP-HP, UVSQ, INRAE, BREED, 78350 Jouy-en-Josas, France
| | - P Chavatte-Palmer
- University Paris-Saclay, AP-HP, UVSQ, INRAE, BREED, 78350 Jouy-en-Josas, France
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Wang H, Xue F, Wang W. A combination of laparoscopy and bilateral uterine artery occlusion for the treatment of type II cesarean scar pregnancy: a retrospective analysis. J Int Med Res 2024; 52:3000605241241010. [PMID: 38663910 PMCID: PMC11047230 DOI: 10.1177/03000605241241010] [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: 12/16/2023] [Accepted: 03/04/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE We investigated the efficacy of a combination of laparoscopy and bilateral uterine artery occlusion (BUAO) for the treatment of type II cesarean scar pregnancy (CSP). METHODS Patients with type II CSP underwent laparoscopy + bilateral uterine artery embolization (control group) or laparoscopy + BUAO (study group). Data regarding the duration of surgery, intraoperative hemorrhage, postoperative complications, the duration of the hospital stay, and the costs of hospitalization were retrospectively collected. One year later, the time to the return of the β-human chorionic gonadotropin (β-hCG) concentration to normal and to the return of menstruation were compared. RESULTS The duration of surgery, time to the return of menstruation, and incidence of postoperative complications in the study group were significantly less than in the control group, but there was no significant difference in the time for β-hCG to return to normal or the volume of intraoperative hemorrhage. The duration of hospitalization and costs for the control group were higher than those for the study group. CONCLUSION Laparoscopy in combination with BUAO is associated with minimal trauma, rapid recovery, a short duration of surgery, low cost of hospitalization, and a low postoperative complication rate. Thus, it represents a useful new surgical treatment for type II CSP.
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Affiliation(s)
- Hongyan Wang
- Department of Gynecology, The First Affiliated Hospital of Xi’an Medical University, Xi’an, Shaanxi Province, China
| | - Fangfang Xue
- Department of Gynecology, The First Affiliated Hospital of Xi’an Medical University, Xi’an, Shaanxi Province, China
| | - Wenying Wang
- Department of Gynecology, The First Affiliated Hospital of Xi’an Medical University, Xi’an, Shaanxi Province, China
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Fu P, Sun H, Zhang L, Liu R. Efficacy and safety of treatment modalities for cesarean scar pregnancy: a systematic review and network meta-analysis. Am J Obstet Gynecol MFM 2024:101328. [PMID: 38485053 DOI: 10.1016/j.ajogmf.2024.101328] [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: 11/29/2023] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE Cesarean scar pregnancy may lead to varying degrees of complications. There are many treatment methods for it, but there are no unified or recognized treatment strategies. This systematic review and network meta-analysis aimed to observe the efficacy and safety of treatment modalities for patients with cesarean scar pregnancy. DATA SOURCES MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched from their inception to January 31, 2024. In addition, relevant reviews and meta-analyses were manually searched for additional references. STUDY ELIGIBILITY CRITERIA Our study incorporated head-to-head trials involving a minimum of 10 women diagnosed with cesarean scar pregnancy through ultrasound imaging or magnetic resonance imaging, encompassing a detailed depiction of primary interventions and any supplementary measures. Trials with a Newcastle-Ottawa scale score <4 were excluded because of their low quality. METHODS We conducted a random-effects network meta-analysis and review for cesarean scar pregnancy. Group-level data on treatment efficacy and safety, reproductive outcomes, study design, and demographic characteristics were extracted following a predefined protocol. The quality of studies was assessed using the Cochrane risk-of-bias tools for randomized controlled trials and the Newcastle‒Ottawa scale for cohort studies and case series. The main outcomes were efficacy (initial treatment success) and safety (complications), of which summary odds ratios and the surface under the cumulative ranking curve using pairwise and network meta-analysis with random effects. RESULTS Seventy-three trials (7 randomized controlled trials) assessing a total of 8369 women and 17 treatment modalities were included. Network meta-analyses were rooted in data from 73 trials that reported success rates and 55 trials that reported complications. The findings indicate that laparoscopy, transvaginal resection, hysteroscopic curettage, and high-intensity focused ultrasound combined with suction curettage demonstrated the highest cure rates, as evidenced by surface under the cumulative ranking curve rankings of 91.2, 88.2, 86.9, and 75.3, respectively. When compared with suction curettage, the odds ratios (95% confidence intervals) for efficacy were as follows: 6.76 (1.99-23.01) for laparoscopy, 5.92 (1.47-23.78) for transvaginal resection, 5.00 (1.99-23.78) for hysteroscopic curettage, and 3.27 (1.08-9.89) for high-intensity focused ultrasound combined with suction curettage. Complications were more likely to occur after receiving uterine artery chemoembolization, suction curettage, methotrexate+hysteroscopic curettage, and systemic methotrexate; hysteroscopic curettage, high-intensity focused ultrasound combined with suction curettage, and Lap were safer than the other options derived from finite evidence; and the confidence intervals of all the data were wide. CONCLUSION Our findings indicate that laparoscopy, transvaginal resection, hysteroscopic curettage, and high-intensity focused ultrasound combined with suction curettage procedures exhibit superior efficacy with reduced complications. The utilization of methotrexate (both locally guided injection and systemic administration) as a standalone medical treatment is not recommended.
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Affiliation(s)
- Peiying Fu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haiying Sun
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Long Zhang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ronghua Liu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Jiang Y, Liu Y, Liu N, Qin S, Zhong S, Huang X. Efficacy and safety of high-intensity focused ultrasound combined with suction curettage for the treatment of caesarean scar pregnancy: a systematic review and single-arm meta-analysis. Int J Hyperthermia 2024; 41:2310019. [PMID: 38329796 DOI: 10.1080/02656736.2024.2310019] [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: 09/25/2023] [Accepted: 01/22/2024] [Indexed: 02/09/2024] Open
Abstract
PURPOSE Caesarean scar pregnancy (CSP) presents a significant clinical challenge owing to the associated risks of uterine scar rupture, severe haemorrhage and adverse maternal outcomes. This study aimed to assess the safety and efficacy of combining high-intensity focused ultrasound (HIFU) with suction curettage for treating CSP. METHODS We conducted a comprehensive search in four databases, namely PubMed, Web of Science, Embase and Cochrane Library, to identify published studies evaluating the use of HIFU combined with suction curettage to treat CSP. Intraoperative blood loss, treatment success rate, and reproductive results were the primary outcomes assessed. RESULTS A total of 18 studies involving 1251 patients with CSP, all of whom received preoperative HIFU therapy were included. The average hospital stay was 6.22 days, the intraoperative blood loss was 26.29 ml and the incidence of adverse events was 15.60%, including abdominal or lower limb pain, fever, vaginal bleeding, haematuria and vomiting. Furthermore, post-treatment follow-up showed that serum β-human chorionic gonadotropin levels were rapidly normalized (average of 25.48 days) and menstruation returned (average of 33.03 days). The treatment had a remarkable success rate of 97.60% and a subsequent pregnancy rate of 68.70%. CONCLUSION While the combination of HIFU and suction-curettage may induce common adverse effects such as lower abdominal or limb pain, these reactions typically do not necessitate therapeutic intervention. Additionally, the size of the gestational sac is a determinant of the procedure's success. In conclusion, HIFU combined with suction curettage demonstrates promising clinical efficacy, safety and favourable reproductive outcomes in managing CSP.
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Affiliation(s)
- Yu Jiang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yang Liu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Nian Liu
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Shize Qin
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Shuting Zhong
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xiaohua Huang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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Verberkt C, Jordans IPM, van den Bosch T, Timmerman D, Bourne T, de Leeuw RA, Huirne JAF. How to perform standardized sonographic examination of Cesarean scar pregnancy in the first trimester. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024. [PMID: 38308856 DOI: 10.1002/uog.27604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 01/06/2024] [Accepted: 01/27/2024] [Indexed: 02/05/2024]
Abstract
Early diagnosis and appropriate management of Cesarean scar pregnancy (CSP) are crucial to prevent severe complications such as uterine rupture, severe hemorrhage and placenta accreta spectrum disorders. In this article, we provide a step-by-step tutorial for the standardized sonographic evaluation of CSP in the first trimester. Practical steps for performing a standardized transvaginal ultrasound examination to diagnose CSP are outlined, focusing on criteria and techniques essential for accurate identification and classification. Key sonographic markers, including gestational sac location, cardiac activity, placental implantation and myometrial thickness, are detailed. The evaluation process is presented according to assessment of the uterine scar, differential diagnosis, detailed CSP evaluation and CSP classification. This step-by-step tutorial emphasizes the importance of scanning in two planes (sagittal and transverse), utilizing color or power Doppler and differentiating CSP from other low-lying pregnancies. The CSP classification is described in detail and is based on the location of the largest part of the gestational sac relative to the uterine cavity and serosal lines. This descriptive classification is recommended for clinical use to stimulate uniform description and evaluation. Such a standardized sonographic evaluation of CSP in the first trimester is essential for early diagnosis and management, helping to prevent life-threatening complications and to preserve fertility. Training sonographers in detailed evaluation techniques and promoting awareness of CSP are critical. The structured approach to CSP diagnosis presented herein is supported by a free e-learning course available online. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C Verberkt
- Department of Obstetrics and Gynecology, Research Institute 'Amsterdam Reproduction and Development', Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
| | - I P M Jordans
- Department of Obstetrics and Gynecology, Research Institute 'Amsterdam Reproduction and Development', Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
| | - T van den Bosch
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - D Timmerman
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - T Bourne
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - R A de Leeuw
- Department of Obstetrics and Gynecology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - J A F Huirne
- Department of Obstetrics and Gynecology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
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Wu T, Wang Q, Liu W, Zhang J, Wang W, Wang J, Ji C, Liu H, Tang C, Mi X. Clinical efficacy and risk factors for suction curettage and hysteroscopy in patients with type I and II cesarean scar pregnancy. Int J Gynaecol Obstet 2024; 164:270-276. [PMID: 37537977 DOI: 10.1002/ijgo.15020] [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: 03/16/2023] [Revised: 06/30/2023] [Accepted: 07/10/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE To investigate the clinical efficacy and evaluate risk factors for suction curettage (SC) and hysteroscopy in the treatment of type I and II cesarean scar pregnancy (CSP). METHODS This was a retrospective study including 100 women diagnosed with type I/II CSP. Patients were treated with either ultrasound-guided SC (SC group) or hysteroscopy resection (surgery group). The success rates, mean operation time, hospitalization duration, hospitalization cost, risk factors, adverse events, and complications were analyzed. RESULTS The success rate of the SC and surgery groups were 85% and 100%, respectively, and the difference was statistically significant (P = 0.032). There was one case of type I CSP and eight cases of type II CSP that failed SC treatment. No failed cases were found in the surgery group. Analysis of the causes of treatment failure revealed that diameter of the gestational sac was a risk factor for SC failure (odds ratio, 19.66 [95% confidence interval {CI}, 1.70-227.72], P = 0.017). Comparing the clinical outcomes between the SC and surgery groups, although the mean operation time of the SC group was significantly shorter than the surgery group (15 [CI, 15-20] vs. 30 [CI, 27-40], P = 0.001), the cost and duration of hospitalization were significantly lower in the surgery group than that in the SC group. No significant differences were observed for adverse events and complications between the two groups (P > 0.05). CONCLUSION Hysteroscopy is an effective and economical method for treating type I/II CSP. Moreover, SC is not recommended for patients with type I/II CSP with a gestation age ≥8 weeks.
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Affiliation(s)
- Tong Wu
- Department of Gynecology, Shunyi Maternal and Children's Hospital of Beijing Children's Hospital, Beijing, China
| | - Qingxuan Wang
- Department of Gynecology, Shunyi Maternal and Children's Hospital of Beijing Children's Hospital, Beijing, China
| | - Wei Liu
- Department of Gynecology, Shunyi Maternal and Children's Hospital of Beijing Children's Hospital, Beijing, China
| | - Jing Zhang
- Department of Ultrasonography, Shunyi Maternal and Children's Hospital of Beijing Children's Hospital, Beijing, China
| | - Wenhui Wang
- Department of Gynecology, Shunyi Maternal and Children's Hospital of Beijing Children's Hospital, Beijing, China
| | - Jun Wang
- Department of Gynecology, Shunyi Maternal and Children's Hospital of Beijing Children's Hospital, Beijing, China
| | - Cuihong Ji
- Department of Gynecology, Shunyi Maternal and Children's Hospital of Beijing Children's Hospital, Beijing, China
| | - Honghui Liu
- Department of Gynecology, Shunyi Maternal and Children's Hospital of Beijing Children's Hospital, Beijing, China
| | - Chunyan Tang
- Department of Gynecology, Shunyi Maternal and Children's Hospital of Beijing Children's Hospital, Beijing, China
| | - Xin Mi
- Department of Gynecology, Shunyi Maternal and Children's Hospital of Beijing Children's Hospital, Beijing, China
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Fu L, Yuan H, Cao H, Zhou Q, Tan X, Guo J. Clinical value of ultrasonic indicators in predicting the outcome of caesarean scar pregnancy after pregnancy termination. BMC Pregnancy Childbirth 2023; 23:863. [PMID: 38102587 PMCID: PMC10722759 DOI: 10.1186/s12884-023-06197-x] [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: 10/24/2022] [Accepted: 12/12/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND To investigate the predictive value of ultrasound indicators in early pregnancy for the outcome of caesarean scar pregnancy (CSP) after pregnancy termination. METHODS This study retrospectively analysed the ultrasound images of 98 CSP patients who underwent transabdominal ultrasound-guided hysteroscopic curettage during early pregnancy at Changsha Hospital for Maternal and Child Health Care between January 2017 and October 2021. Patients were equally divided into a case group and a control group. The case group included 49 CSP patients with postoperative complications, such as intraoperative blood loss ≥ 200 ml or retained products of conception (RPOC). The remaining 49 CSP patients, with similar age and gestational age and with good postoperative outcomes, such as intraoperative blood loss ≤ 50 ml and no RPOC, were included in the control group. CSP was classified into three types according to the location of the gestational sac (GS) relative to the uterine cavity line (UCL) and serosal contour. Differences in ultrasound indicators between the case and control group were compared. RESULTS There were significant differences between the case and control groups in the mean gestational sac diameter (MGSD), residual myometrium thickness (RMT) between the GS and the bladder, blood flow around the GS at the site of the previous caesarean incision, and types of CSP (P < 0.05). The rs of each ultrasound indicator were as follows: 0.258, -0.485, 0.369, 0.350. The optimal threshold for predicting good postoperative outcomes, such as intraoperative blood loss ≤ 50 ml and no RPOC, by receiver operating characteristic (ROC) curve analysis of the RMT was 2.3 mm. CONCLUSION Our findings show that the RMT, blood flow around the GS at the site of the previous caesarean incision, and types of CSP have a low correlation with postoperative complications, such as intraoperative blood loss ≥ 200 ml or RPOC, of early pregnancy termination in patients with CSP. To some extent, this study may be helpful for clinical prognostic prediction of patients with CSP and formulation of treatment strategies. Given the low correlation between these three indicators and postoperative complications, further studies are needed to identify indicators that can better reflect the postoperative outcomes of CSP patients.
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Affiliation(s)
- Liye Fu
- Department of Ultrasound, Changsha Hospital for Maternal & Child Health Care Affiliated to Hunan Normal University, Changsha, Hunan, 410000, China
| | - Hongxia Yuan
- Department of Ultrasound, Changsha Hospital for Maternal & Child Health Care Affiliated to Hunan Normal University, Changsha, Hunan, 410000, China.
| | - Hong Cao
- Department of Ultrasound, Changsha Hospital for Maternal & Child Health Care Affiliated to Hunan Normal University, Changsha, Hunan, 410000, China
| | - Qichang Zhou
- Department of Ultrasound, the Second Xiangya Hospital of Central South University, Changsha, Hunan, 410000, China
| | - Xiaotan Tan
- Department of Ultrasound, Changsha Hospital for Maternal & Child Health Care Affiliated to Hunan Normal University, Changsha, Hunan, 410000, China
| | - Jun Guo
- Department of Ultrasound, Changsha Hospital for Maternal & Child Health Care Affiliated to Hunan Normal University, Changsha, Hunan, 410000, China
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Wang S, Hu Q, Liao H, Wang K, Yu H. Perinatal Outcomes of Pregnancy in Women with Scarred Uteri. Int J Womens Health 2023; 15:1453-1465. [PMID: 37746587 PMCID: PMC10517689 DOI: 10.2147/ijwh.s422187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/09/2023] [Indexed: 09/26/2023] Open
Abstract
Objective Uterine scarring is risky for the pregnancy and is closely associated with adverse pregnancy outcomes. Here, we investigated risk factors and associated perinatal outcomes in singleton pregnant women with uterine scars. Methods This retrospective cohort study was conducted on singleton pregnant women who delivered at the West China Second University Hospital between January 1, 2021, and December 31, 2021. Results The control group included 13,433 cases without uterine scars. The study group involved 2397 cases with one previous cesarean delivery (PCD), 163 cases with two PCDs, 12 cases with three PCDs, and 184 cases with non-cesarean uterine scars. The study group had a significantly higher incidence of placenta previa (6.4%), placenta percreta (5.3%), preterm delivery (10.3%), postpartum hemorrhage (3.4%), uterine rupture (9.4%), hysterectomy (0.18%), and bladder injury (0.4%) when compared with the control group (P <0.05). The scarred uterus cases with 1, 2, or 3 PCDs had significantly different complications, with the higher PCD frequency correlating with increased rates of placenta previa, placenta percreta, postpartum hemorrhage, uterine rupture, and uterine resection. Moreover, the hospitalization time, cesarean operation time, and intrapartum bleeding in the current pregnancy significantly increased with increasing PCD frequency (P <0.05). Analysis of the association between the duration of the interval between PCD and re-pregnancy and pregnancy complication revealed that the incidence of pernicious placenta previa was statistically higher in cases with intervals of <2 years or ≥5 years (4.7%) than in cases with 2 years ≤ interval time <5 years (2.5%) (P <0.05). Conclusion Pregnancies with uterine scars may experience higher rates of adverse perinatal outcomes. This calls for increased observation during pregnancy and delivery to reduce maternal and fetal complications.
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Affiliation(s)
- Si Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People’s Republic of China
| | - Qing Hu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People’s Republic of China
| | - Hua Liao
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People’s Republic of China
| | - Kana Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People’s Republic of China
| | - Haiyan Yu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People’s Republic of China
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Bonito G, Masselli G, Gigli S, Ricci P. Imaging of Acute Abdominopelvic Pain in Pregnancy and Puerperium-Part I: Obstetric (Non-Fetal) Complications. Diagnostics (Basel) 2023; 13:2890. [PMID: 37761257 PMCID: PMC10528445 DOI: 10.3390/diagnostics13182890] [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: 07/30/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Acute abdominopelvic pain in pregnant and postpartum patients presents clinical and therapeutic challenges, often requiring quick and accurate imaging diagnosis. Ultrasound remains the primary imaging investigation. Magnetic resonance imaging (MRI) has been shown to be a powerful diagnostic tool in the setting of acute abdominal pain during pregnancy and puerperium. MRI overcomes some drawbacks of US, avoiding the ionizing radiation exposure of a computed tomography (CT) scan. Although CT is not usually appropriate in pregnant patients, it is crucial in the emergency evaluation of postpartum complications. The aim of this article is to provide radiologists with a thorough familiarity with the common and uncommon pregnancy and puerperium abdominal emergencies by illustrating their imaging appearances. The present first section will review and discuss the imaging findings for acute abdominopelvic pain of obstetric (non-fetal) etiology.
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Affiliation(s)
- Giacomo Bonito
- Department of Emergency Radiology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.B.); (P.R.)
| | - Gabriele Masselli
- Department of Emergency Radiology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.B.); (P.R.)
| | - Silvia Gigli
- Department of Diagnostic Imaging, Sandro Pertini Hospital, Via dei Monti Tiburtini 385, 00157 Rome, Italy;
| | - Paolo Ricci
- Department of Emergency Radiology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.B.); (P.R.)
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
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Wu DM, Zhu L, Lin T, Chen S, Wu SS, Lin N. The Application Value of Contrast-Enhanced Ultrasonography in Assessing the Efficacy of Ultrasound-Guided Lauromacrogol Injections in Cesarean Scar Pregnancies. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2125-2133. [PMID: 37129166 DOI: 10.1002/jum.16236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/01/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To investigate the application value of contrast-enhanced ultrasonography (CEUS) in ultrasound-guided lauromacrogol injections in patients with cesarean scar pregnancies (CSP). METHODS A total of 31 patients diagnosed with CSP, who underwent an ultrasound-guided lauromacrogol injection + curettage in our hospital between February 2019 and December 2020 and had a complete recovery confirmed by a postoperative ultrasound review and serum β-human chorionic gonadotropin (β-hCG) assay, were enrolled as the study subjects. According to the volume of intraoperative blood loss and the duration of postoperative vaginal bleeding, the patients were divided into two groups, with 19 in the significantly effective group (Group A) and 12 in the effective group (Group B). The recorded clinical data, including age, duration of amenorrhea, number of pregnancies, number of deliveries, time since last cesarean delivery, number of cesarean deliveries, and preoperative serum β-hCG levels, were retrospectively analyzed. The morphological indicators in CEUS before the lauromacrogol injection, as well as immediately and 12-24 hours after the injection, were compared between the groups. RESULTS In Group A, the post-injection CEUS showed no enhancement, single strip enhancement, and sparse punctate enhancement, while in Group B, it showed a more irregular ring and local patch enhancement. In addition, the number of cases where the CEUS showed no enhancement 12-24 hours after the injection was more than that of the immediate CEUS after the injection. In Group A, four (21.1%) cases showed a single strip-like blood flow on the immediate postoperative CEUS, four (21.1%) cases showed a sparsely dotted blood flow on the immediate postoperative CEUS, and three cases turned into no enhancement 12-24 hours after the injection. A total of four cases in Group B showed that the contrast enhancement range 12-24 hours after the injection was reduced compared with that of the immediate contrast after the injection. CONCLUSION Contrast-enhanced ultrasonography can guide the location selection of the lauromacrogol injection in patients with CSP, and its postoperative morphological indicators can adequately predict the therapeutic effect after curettage and guide clinical management.
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Affiliation(s)
- Dao-Ming Wu
- Department of Ultrasonography, Provincial Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Lin Zhu
- Department of Ultrasonography, Provincial Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Tan Lin
- Department of Obstetrics and Gynecology, Provincial Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Sheng Chen
- Department of Ultrasonography, Provincial Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Song-Song Wu
- Department of Ultrasonography, Provincial Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Ning Lin
- Department of Ultrasonography, Provincial Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
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Mu L, Weng H, Dong Y. Analysis of risk factors for patients with cesarean scar pregnancy treated with methotrexate combined with suction curettage. Arch Gynecol Obstet 2023; 308:913-918. [PMID: 37131042 DOI: 10.1007/s00404-023-07049-x] [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: 01/28/2023] [Accepted: 04/11/2023] [Indexed: 05/04/2023]
Abstract
PURPOSE To analyze the predictive value of clinical and ultrasound parameters for treatment failure after administration of methotrexate (MTX) in combination with suction curettage (SC) in treatment of cesarean scar pregnancy (CSP) in the early first trimester. METHODS In this retrospective cohort study, electronic medical records of patients diagnosed with CSP and initially treated between 2015 and 2022 with MTX combined with SC were reviewed and outcome data were collected. RESULTS 127 patients met inclusion criteria. 25 (19.69%) required additional treatment. Logistic regression analysis indicated that factors independently associated with the need for additional treatment included progesterone level > 25 mIU/mL (OR: 1.97; 95% CI: 0.98-2.87, P = 0.039), abundant blood flow (OR: 5.19; 95% CI: 2.44-16.31, P = 0.011), gestational sac size > 3 cm (OR: 2.54; 95% CI: 1.12-6.87, P = 0.029), and the myometrial thickness between the bladder and gestational sac < 2.5 mm (OR: 3.48; 95% CI: 1.91-6.98, P = 0.015). CONCLUSIONS Our study identified several factors which increase the need for additional treatment following the initial treatment of CSP with MTX and SC. Alternative therapy should be considered if these factors are present.
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Affiliation(s)
- Lin Mu
- Department of Gynecology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Zhejiang Province, Hangzhou, China.
| | - Huifang Weng
- Department of Ultrasound, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Province, Hangzhou, China
| | - Yan Dong
- Department of Gynecology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Zhejiang Province, Hangzhou, China
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18
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Sokalska A, Rambhatla A, Dudley C, Bhagavath B. Nontubal ectopic pregnancies: overview of diagnosis and treatment. Fertil Steril 2023; 120:553-562. [PMID: 37495011 DOI: 10.1016/j.fertnstert.2023.07.014] [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: 05/23/2023] [Revised: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 07/28/2023]
Abstract
Nontubal ectopic pregnancies occur as a result of embryo implantation outside the uterine cavity and fallopian tubes. Sites include ovary, cervix, abdominal cavity, interstitial portion of fallopian tube, and cesarean scar. Nontubal pregnancies are uncommon. Nonspecific signs and symptoms of nontubal ectopic pregnancies make diagnosis challenging and, in many cases, significantly delayed, resulting in a high rate of morbidity. Although surgical management remains the mainstay of treatment, there is growing evidence that some of these can be managed medically or with the use of a combination of medical and surgical approaches with good outcome. This review summarizes the current diagnostic modalities, therapeutic options, and outcomes for nontubal ectopic pregnancies. Diagnostic and management options may be limited, especially in resource-restricted settings. Therefore, an understanding of the available options is critical. It needs to be emphasized that the rarity of cases and the difficulties in organizing ethically justified randomized trials result in the lack of well-established management guidelines for nontubal ectopic pregnancies.
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Affiliation(s)
- Anna Sokalska
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California.
| | - Anupama Rambhatla
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California
| | - Christina Dudley
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin
| | - Bala Bhagavath
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin
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19
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Verberkt C, Lemmers M, de Vries R, Stegwee SI, de Leeuw RA, Huirne JAF. Aetiology, risk factors and preventive strategies for niche development: A review. Best Pract Res Clin Obstet Gynaecol 2023; 90:102363. [PMID: 37385157 DOI: 10.1016/j.bpobgyn.2023.102363] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/03/2023] [Accepted: 05/14/2023] [Indexed: 07/01/2023]
Abstract
The increase in caesarean sections (CS) has resulted in an increase in women with a uterine niche. The exact aetiology of niche development has yet to be elucidated but is likely multifactorial. This study aimed to give a systematic overview of the available literature on histopathological features, risk factors and results of preventive strategies on niche development to gain more insight into the underlying mechanisms. Based on current published data histopathological findings associated with niche development were necrosis, fibrosis, inflammation, adenomyosis and insufficient approximation. Patient-related risk factors included multiple CS, BMI and smoking. Labour-related factors were CS before onset of labour, extended cervical dilatation, premature rupture of membranes and presenting part of the fetus at CS below the pelvic inlet. Preventive strategies should focus on the optimal level of incision, training of surgeons and full-thickness closure of the myometrium (single or double-layer) using non-locking sutures. Conflicting data exist concerning the effect of endometrial inclusion. Future studies without heterogeneity in population, using standardized performance of the CS after proper training and using standardized niche evaluation with a relevant core outcome set are required to allow meta-analyses and to develop evidence-based preventive strategies. These studies are needed to reduce the prevalence of niches and prevent complications in subsequent pregnancies such as caesarean scar pregnancies.
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Affiliation(s)
- C Verberkt
- Department of Obstetrics and Gynecology, Research Institute "Amsterdam Reproduction and Development", Amsterdam UMC, Location VU Medical Center, Amsterdam, the Netherlands
| | - M Lemmers
- Department of Obstetrics and Gynecology, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - R de Vries
- Medical Library, Vrije Universiteit, 1081 HV, Amsterdam, the Netherlands
| | - S I Stegwee
- Department of Obstetrics and Gynecology, Research Institute "Amsterdam Reproduction and Development", Amsterdam UMC, Location VU Medical Center, Amsterdam, the Netherlands; Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - R A de Leeuw
- Department of Obstetrics and Gynecology, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - J A F Huirne
- Department of Obstetrics and Gynecology, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands.
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20
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Huang J, Phillips C, Moshiri M. Scarred for life: a review of cesarean section scar pregnancy and potential pitfalls in diagnosis. Abdom Radiol (NY) 2023; 48:2672-2683. [PMID: 37204508 DOI: 10.1007/s00261-023-03953-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/20/2023]
Abstract
Cesarean section scar pregnancy (CSSP) is defined as abnormal implantation of a gestational sac on or in a previous cesarean section scar. There is an increasing incidence of detection of CSSP, likely in part due to the growing rates of cesarean deliveries and the improved rates of detection with advancing ultrasound technology. Diagnosis of CSSP is critical due to the potentially life-threatening complications to the mother if left untreated. Pelvic ultrasound is the imaging modality of choice in the initial evaluation of suspected CSSP, with MRI potentially useful if ultrasound findings are equivocal, or if confirmation is requested prior to definitive intervention. Early and accurate diagnosis of CSSP allows for prompt management to avoid severe complications and the potential to preserve the uterus and future fertility. A combination of medical and surgical treatment strategies may be needed with specific therapy tailored to each patient. Follow-up after treatment should include serial beta-hCG levels and possible repeat imaging if there is clinical concern for complications or treatment failure. This article will provide a comprehensive review of this uncommon but important phenomenon, detailing the pathophysiology and types of CSSP, imaging presentations, potential pitfalls in diagnosis, and management options.
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Affiliation(s)
- Jennifer Huang
- Department of Radiology, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, USA.
- PGY-5 Chief Resident, Diagnostic Radiology Residency, Vanderbilt University Medical Center, 1161 21st Ave South, Nashville, TN, 37232, USA.
| | - Catherine Phillips
- Department of Radiology, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, USA
| | - Mariam Moshiri
- Department of Radiology, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, USA
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21
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Klein Meuleman SJM, Min N, Hehenkamp WJK, Post Uiterweer ED, Huirne JAF, de Leeuw RA. The definition, diagnosis, and symptoms of the uterine niche - A systematic review. Best Pract Res Clin Obstet Gynaecol 2023; 90:102390. [PMID: 37506497 DOI: 10.1016/j.bpobgyn.2023.102390] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023]
Abstract
Of all neonates, 21% are delivered by cesarean section (CS). A long-term maternal complication of an SC is a uterine niche. The aim of this review is to provide an overview of the current literature on imaging techniques and niche-related symptomatology. We performed systematic searches on imaging and niche symptoms. For both searches, 87 new studies were included. Niche evaluation by transvaginal sonography (TVS) or contrast sonohysterography (SHG) proved superior over hysteroscopy or magnetic resonance imaging. Studies that used SHG in a random population identified a niche prevalence of 42%-84%. Niche prevalence differed based on niche definition, symptomatology, and imaging technique. Most studies reported an association with gynecological symptoms, poor reproductive outcomes, obstetrical complications, and reduced quality of life. In conclusion, non-invasive TVS and SHG are the superior imaging modalities to diagnose a niche. Niches are prevalent and strongly associated with gynecological symptoms and poor reproductive outcomes.
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Affiliation(s)
- S J M Klein Meuleman
- Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam, Department of Obstetrics & Gynaecology, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
| | - N Min
- Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam, Department of Obstetrics & Gynaecology, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
| | - W J K Hehenkamp
- Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam, Department of Obstetrics & Gynaecology, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - E D Post Uiterweer
- Amsterdam University Medical Center, Location Amsterdam Medical Center, Uterine Repair Center, Department of Obstetrics & Gynaecology, Meibergdreef 9, Amsterdam, the Netherlands.
| | - J A F Huirne
- Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam, Department of Obstetrics & Gynaecology, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
| | - R A de Leeuw
- Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam, Department of Obstetrics & Gynaecology, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
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22
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Van X, Bui T, Dinh HT, Van T, Tran A. The Effectiveness of Combined Local and Systemic Methotrexate Treatment in Cesarean Scar Pregnancy Weeks 8 to 14. Gynecol Minim Invasive Ther 2023; 12:170-174. [PMID: 37807983 PMCID: PMC10553595 DOI: 10.4103/gmit.gmit_135_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/20/2023] [Accepted: 03/31/2023] [Indexed: 10/10/2023] Open
Abstract
Objectives This study aims to identify the success rate and correlated factors of combined local and systemic methotrexate (MTX) injection treatment in cesarean scar pregnancy (CSP). Materials and Methods The combined local and systemic MTX administration has been used for CSP weeks 8-14 at Tu Du Maternal Hospital; however, its effectiveness and correlated factors have not been closely investigated. This is a retrospective case series of 123 CSP patients between 8 and 14 weeks of gestation who were treated at Tu Du Hospital from the year 2016 to 2020. Results The success rate, uterine-sparing rate, and side effects of MTX treatment are 50.4%, 95%, and 17.2%, respectively. The factors related to treatment failure with statistical significance included gestational age (odds ratio [OR] = 3.99), residual myometrial thickness >3 mm (OR = 0.37), and postprocedure gestational sac diameter (OR = 1.09). Conclusion Combined local and systemic MTX injection is minimally invasive and effective in CSP weeks 8-14. Therefore, it should be utilized routinely.
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Affiliation(s)
- Xuyen Van
- Department of Obstretric and Gynecology, Tu Du Maternal Hospital, Long An, Vietnam
| | - Thuong Bui
- Department of Obstretric and Gynecology, University of Medicine and Pharmacy, Long An, Vietnam
| | - Hoang The Dinh
- Department of Obstretric and Gynecology, School of Medicine, Vietnam National University, Long An, Vietnam
| | - Thong Van
- Department of Obstretric and Gynecology, TWG Hospital, Long An, Vietnam
| | - Anh Tran
- Department of Obstretric and Gynecology, My Duc Hospital, Ho Chi Minh City, Vietnam
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23
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Wu BT, Feld Z, Creinin MD. Management of cesarean scar ectopic pregnancies at an academic referral center: A case series. Contraception 2023; 123:110021. [PMID: 36940910 DOI: 10.1016/j.contraception.2023.110021] [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: 12/06/2022] [Revised: 03/04/2023] [Accepted: 03/13/2023] [Indexed: 03/22/2023]
Abstract
OBJECTIVES To describe treatment and outcomes of patients with confirmed cesarean scar ectopic pregnancy (CSEP) at a tertiary referral center. STUDY DESIGN We reviewed a deidentified family planning clinical database for patients seen by our subspecialty service for CSEP from January 2017 through December 2021 in this case series. We extracted referral information, final diagnosis, management, and outcome measures including estimated blood loss, secondary procedures, and treatment complications. RESULTS Of 57 cases referred for suspected CSEPs, 23 (40%) had confirmed diagnoses; one additional case was diagnosed during clinic evaluation for early pregnancy loss. Most (n = 50 [88%]) referrals occurred in the last 2 years of the 5-year study period. Of 24 confirmed CSEP cases, eight were pregnancy losses at the time of diagnosis. Fourteen cases were ≤50 days gestation or gestational size (7 [50%] pregnancy losses) and 10 >50 days gestation (range 39-66 days). We treated all 14 patients ≤50 days primarily with suction aspiration under ultrasound guidance in an operating room with no complications and estimated blood loss of 14 ± 10 mL. Of the 10 patients>50 days (maximum 66 days), seven were managed with primary aspiration of which five were uncomplicated. We treated one patient (57 days) had primary intrauterine double-catheter balloon with immediate hemorrhage requiring uterine artery embolization followed by an uncomplicated suction aspiration. CONCLUSIONS Patients with confirmed CSEPs at 50 days or less gestation or gestational size can likely be primarily treated with suction aspiration with low risk for significant adverse outcomes. Treatment success and complications are directly related to gestational age at treatment. IMPLICATIONS Ultrasound-guided suction aspiration monotherapy should be considered for primary CSEP treatment up to 50 days and, with continued experience, may be reasonable beyond 50 days gestation. Invasive treatments or those that require multiple days and visits, such as methotrexate or balloon catheters, are not necessary for early CSEPs.
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Affiliation(s)
- Brenda T Wu
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, USA
| | - Zoe Feld
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, USA
| | - Mitchell D Creinin
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, USA.
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24
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Rahman J, Qiu Y, Yuan X, Kassim SH, Ji T, Dai H. Pituitrin Injection before Hysteroscopic Curettage for Treating Type I Cesarean Scar Pregnancy in Comparison with Uterine Artery Embolization: A Retrospective Study. J Obstet Gynaecol India 2023; 73:229-234. [PMID: 37324364 PMCID: PMC10267048 DOI: 10.1007/s13224-022-01724-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 10/23/2022] [Indexed: 12/23/2022] Open
Abstract
Background The effectiveness and safety of pituitrin injection coupled with hysteroscopy and suction curettage as treatment for type I cesarean scar pregnancy (CSP) have not been studied enough in the literature, by comparing it to uterine artery embolization (UAE) followed by suction curettage we aim to determine its efficacy. Materials and Methods Data of 53 patients (the PIT group) with type I CSP treated with pituitrin injection combined with hysteroscopic suction curettage and 137 patients (the UAE group) with type I CSP treated with UAE followed by suction curettage were collected in retrospect. The clinical data were analyzed statistically to compare the efficacy and safety between the two groups. Results The PIT group had a shorter duration of postoperative vaginal bleeding, postoperative hospitalization, and overall hospitalization length (P < 0.05). The PIT group had lower overall hospitalization costs and a lower rate of adverse events than the UAE group (P < 0.05). There was no significant difference between the two groups in terms of treatment success rate, the average length of operation, blood loss during the procedure, time when serum β-hCG returned to normal range, and menstrual recovery time after hospital release (P > 0.05). Conclusion UAE and pituitrin injection followed by hysteroscopic suction curettage are good choices for type I CSP treatment. However, pituitrin injection with hysteroscopic suction curettage outperforms UAE followed by suction curettage. Thus, pituitrin injection may be an option of high priority for type I CSP.
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Affiliation(s)
- Juveria Rahman
- Department of Gynecology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, 300 Guangzhoulu, Gulou District, Nanjing, Jiangsu 210029 China
| | - Yixuan Qiu
- Department of Gynecology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, 300 Guangzhoulu, Gulou District, Nanjing, Jiangsu 210029 China
| | - Xiong Yuan
- Department of Gynecology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, 300 Guangzhoulu, Gulou District, Nanjing, Jiangsu 210029 China
| | | | - Tonghui Ji
- Department of Gynecology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, 300 Guangzhoulu, Gulou District, Nanjing, Jiangsu 210029 China
| | - Huihua Dai
- Department of Gynecology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, 300 Guangzhoulu, Gulou District, Nanjing, Jiangsu 210029 China
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25
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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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Nijjar S, Jauniaux E, Jurkovic D. Definition and diagnosis of cesarean scar ectopic pregnancies. Best Pract Res Clin Obstet Gynaecol 2023; 89:102360. [PMID: 37356119 DOI: 10.1016/j.bpobgyn.2023.102360] [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: 04/01/2023] [Revised: 05/10/2023] [Accepted: 05/14/2023] [Indexed: 06/27/2023]
Abstract
Cesarean scar ectopic pregnancy is a rare type of ectopic pregnancy, where the pregnancy implants into a myometrial defect caused by a cesarean scar. Its incidence is predicted to increase, given the global increase in cesarean deliveries. As most cesarean scar ectopic pregnancies present as failing pregnancies or patients choose termination of pregnancy, there are limited data on their natural history. However, early first trimester diagnosis is essential, given the associated significant maternal morbidity. Transvaginal sonography is generally considered to be the optimal method for diagnosing cesarean scar ectopic pregnancy. There is no evidence that MRI adds to the diagnostic accuracy, and it is therefore not recommended for routine evaluation of cesarean scar ectopic pregnancy. There is no agreed reference standard for the diagnosis of cesarean scar ectopic pregnancy; therefore, the validity of several proposed sonographic diagnostic criteria reported by different authors remains unknown. There are also various suggested classification systems for cesarean scar ectopic pregnancy, which divide them in differet types. However, the proposals are very heterogeneous, and superiority of one classification system over another is yet to be established.
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Affiliation(s)
- Simrit Nijjar
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, UK.
| | - Eric Jauniaux
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, UK.
| | - Davor Jurkovic
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, UK.
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27
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Ban Y, Shen J, Wang X, Zhang T, Lu X, Qu W, Hao Y, Mao Z, Li S, Tao G, Wang F, Zhao Y, Zhang X, Zhang Y, Zhang G, Cui B. Cesarean Scar Ectopic Pregnancy Clinical Classification System With Recommended Surgical Strategy. Obstet Gynecol 2023; 141:927-936. [PMID: 37023450 PMCID: PMC10108840 DOI: 10.1097/aog.0000000000005113] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/15/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE To establish a new cesarean scar ectopic pregnancy clinical classification system with recommended individual surgical strategy and to evaluate its clinical efficacy in treatment of cesarean scar ectopic pregnancy. METHODS This retrospective cohort study included patients with cesarean scar ectopic pregnancy in Qilu Hospital in Shandong, China. From 2008 to 2015, patients with cesarean scar ectopic pregnancy were included to determine risk factors for intraoperative hemorrhage during cesarean scar ectopic pregnancy treatment. Univariable analysis and multivariable logistic regression analyses were used to explore the independent risk factors for hemorrhage (300 mL or greater) during a cesarean scar ectopic pregnancy surgical procedure. The model was internally validated with a separate cohort. Receiver operating characteristic curve methodology was used to identify optimal thresholds for the identified risk factors to further classify cesarean scar ectopic pregnancy risk, and the recommended operative treatment was established for each classification group by expert consensus. A final cohort of patients from 2014 to 2022 were classified according to the new classification system, and the recommended surgical procedure and clinical outcomes were abstracted from the medical record. RESULTS Overall, 955 patients with first-trimester cesarean scar ectopic pregnancy were included; 273 were used to develop a model to predict intraoperative hemorrhage with cesarean scar ectopic pregnancy, and 118 served as an internal validation group for the model. Anterior myometrium thickness at the scar (adjusted odds ratio [aOR] 0.51, 95% CI 0.36-0.73) and average diameter of the gestational sac or mass (aOR 1.10, 95% CI 1.07-1.14) were independent risk factors for intraoperative hemorrhage of cesarean scar ectopic pregnancy. Five clinical classifications of cesarean scar ectopic pregnancy were established on the basis of the thickness and gestational sac diameter, and the optimal surgical option for each type was recommended by clinical experts. When the classification system was applied to a separate cohort of 564 patients with cesarean scar ectopic pregnancy, the overall success rate of recommended first-line treatment with the new classification grouping was 97.5% (550/564). No patients needed to undergo hysterectomy. Eighty-five percent of patients had a negative serum β-hCG level within 3 weeks after the surgical procedure; 95.2% of patients resumed their menstrual cycles within 8 weeks. CONCLUSION Anterior myometrium thickness at the scar and the diameter of the gestational sac were confirmed to be independent risk factors for intraoperative hemorrhage during cesarean scar ectopic pregnancy treatment. A new clinical classification system based on these factors with recommended surgical strategy resulted in high treatment success rates with minimal complications.
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Affiliation(s)
- Yanli Ban
- Department of Obstetrics and Gynaecology, the Department of Ultrasound, the Department of Radiology, and the Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, China
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28
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Tavares BVG, Delfino LS, Ignarro IS, Baccaro LF. Changing Paradigms in the Initial Treatment of Ectopic Pregnancy at a University Hospital in Brazil. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:192-200. [PMID: 37224841 PMCID: PMC10208733 DOI: 10.1055/s-0043-1768999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVE To evaluate the use of different treatment options for ectopic pregnancy and the frequency of severe complications in a university hospital. METHODS Observational study with women with ectopic pregnancy admitted at UNICAMP Womeńs Hospital, Brazil, between 01/01/2000 and 12/31/2017. The outcome variables were the type of treatment (first choice) and the presence of severe complications. Independent variables were clinical and sociodemographic data. Statistical analysis was carried out by the Cochran-Armitage test, chi-square test, Mann-Whitney test and multiple Cox regression. RESULTS In total 673 women were included in the study. The mean age was 29.0 years (± 6.1) and the mean gestational age was 7.7 (± 2.5). The frequency of surgical treatment decreased significantly over time (z = -4.69; p < 0.001). Conversely, there was a significant increase in the frequency of methotrexate treatment (z = 4.73; p < 0.001). Seventy-one women (10.5%) developed some type of severe complication. In the final statistical model, the prevalence of severe complications was higher in women who were diagnosed with a ruptured ectopic pregnancy at admission (PR = 2.97; 95%CI: 1.61-5.46), did not present with vaginal bleeding (PR = 2.45; 95%CI: 1.41-4.25), had never undergone laparotomy/laparoscopy (PR = 6.69; 95%CI: 1.62-27.53), had a non-tubal ectopic pregnancy (PR = 4.61; 95%CI: 1.98-10.74), and do not smoke (PR = 2.41; 95%CI: 1.08-5.36). CONCLUSION there was a change in the first treatment option for cases of ectopic pregnancy in the hospital during the period of analysis. Factors inherent to a disease that is more difficult to treat are related to a higher frequency of severe complications.
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Affiliation(s)
| | - Letícia Sathler Delfino
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | | | - Luiz Francisco Baccaro
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil
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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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He C, Xia W, Yan L, Wang Y, Tian Y, Mol BW, Zhang J, Huirne J. Fertility outcomes after hysteroscopic niche resection compared with expectant management in women with a niche in the uterine cesarean scar. Eur J Obstet Gynecol Reprod Biol 2023; 284:136-142. [PMID: 36989689 DOI: 10.1016/j.ejogrb.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 03/01/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE To determine whether hysteroscopic niche resection (HNR) and expectant management are suitable in women with fertility desire and a niche with a residual myometrium thickness (RMT) ≥ 2.5 mm. STUDY DESIGN This retrospective cohort study was conducted at International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China between September 2016 and December 2021. We reported the fertility outcomes between women (with fertility desire and a niche with RMT ≥ 2.5 mm) who received HNR or expectant management. RESULTS We studied 166 women, of whom 72 accepted HNR and 94 accepted expectant management. The HNR group included more symptomatic women, in terms of postmenstrual spotting or infertility. No differences were found regarding niche measures before treatment. The live birth rate was comparable in both groups (HNR versus expectant management as 55.5% versus 45.7%, risk ratio = 1.48, 95% Cl 0.80-2.75, p = 0.21). The pregnancy rate was higher in HNR group than that in expectant management group (n = 72.2% versus n = 56.4%, risk ratio = 2.01, 95% CI 1.04-3.88, p = 0.04). In a subgroup of women with infertility before entry in the study, HNR resulted in a significant higher live birth rate (p = 0.04) and pregnancy rate (p = 0.01). CONCLUSION In women with infertility with a symptomatic niche with RMT ≥ 2.5 mm, HNR may be superior to expectant management. This retrospective cohort biased selection against a randomized study, our results still need to be validated in the future with larger clinical multicenter randomized controlled trials.
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Affiliation(s)
- Chuqing He
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China; Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China
| | - Wei Xia
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China; Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China
| | - Li Yan
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China; Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China
| | - Yang Wang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China; Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China
| | - Yuan Tian
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China; Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China
| | - Ben W Mol
- Department of Obstetrics and Gynecology, Monash University, 246 Clayton Road, Clayton 3168, Victoria, Australia; Aberdeen Centre for Women's Health Research, University of Aberdeen, Aberdeen, UK
| | - Jian Zhang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China; Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China.
| | - Jaf Huirne
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Centre, Location AMC and VUmc, Amsterdam, The Netherlands
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Xia W, Wang X, Wang Y, Tian Y, He C, Zhu C, Zhu Q, Huang H, Shi L, Zhang J. Comparative effectiveness of transvaginal repair vs. hysteroscopic resection in patients with symptomatic uterine niche. Front Surg 2023; 10:1019237. [PMID: 36843994 PMCID: PMC9947358 DOI: 10.3389/fsurg.2023.1019237] [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: 08/14/2022] [Accepted: 01/19/2023] [Indexed: 02/11/2023] Open
Abstract
Objective To compare the efficacy of transvaginal repair and hysteroscopic resection in improving niche associated postmenstrual spotting. Methods The improvement rate of postmenstrual spotting in women who underwent transvaginal repair or hysteroscopic resection treatment was assessed retrospectively in patients accepted at the Niche Sub-Specialty Clinic in International Peace Maternity and Child Health Hospital between June 2017 and June 2019. Postoperative spotting symptom within one year after surgery, pre- and postoperative anatomical indicators, women' satisfaction with menstruation and other perioperative parameters were compared between the two groups. Results 68 patients in the transvaginal group and 70 patients in the hysteroscopic group were included for analysis. The improvement rate of postmenstrual spotting in the transvaginal group at the 3rd, 6th, 9th, and 12th months after surgery was 87%, 88%, 84%, and 85%, significantly higher than 61%, 68%, 66%, and 68% in the hysteroscopic group, respectively (P < 0.05). The total days of spotting improved significantly at the 3rd month after surgery but did not change over time within one year in each group (P > 0.05). After surgery, the disappearance rates of the niche are 68% in transvaginal group and 38% in hysteroscopic group, however, hysteroscopic resection had shorter operative time and hospitalization duration, less complications, and lower hospitalization costs. Conclusion Both treatments can improve the spotting symptom and anatomical structures of uterine lower segments with niches. Transvaginal repair is better in thickening the residual myometrium than hysteroscopic resection, however, hysteroscopic resection has shorter operative time and hospitalization duration, less complications, and lower hospitalization costs.
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Affiliation(s)
- Wei Xia
- Department of Gynecology and Obstetrics, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Xiaofeng Wang
- Department of Gynecology and Obstetrics, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Yang Wang
- Department of Gynecology and Obstetrics, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Yuan Tian
- Department of Gynecology and Obstetrics, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Chuqing He
- Department of Gynecology and Obstetrics, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Chenfeng Zhu
- Department of Gynecology and Obstetrics, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Qian Zhu
- Department of Gynecology and Obstetrics, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Hefeng Huang
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China,Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China,Correspondence: Hefeng Huang Liye Shi Jian Zhang
| | - Liye Shi
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China,Department of Ultrasound, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Correspondence: Hefeng Huang Liye Shi Jian Zhang
| | - Jian Zhang
- Department of Gynecology and Obstetrics, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China,Correspondence: Hefeng Huang Liye Shi Jian Zhang
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Cardaillac C, Salmon C, Vaucel E, Gueudry P, Lavoue V, Nyangoh Timoh K, Thubert T. Robot-assisted laparoscopy repair of uterine isthmocele: A two-center observational study. Int J Gynaecol Obstet 2023; 160:244-248. [PMID: 35749544 DOI: 10.1002/ijgo.14319] [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: 12/30/2021] [Revised: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To analyze outcomes and postoperative complications in patients undergoing robot-assisted isthmocele repair. METHOD This retrospective cohort study included 33 patients who had robot-assisted laparoscopic surgical management of an isthmocele between September 2013 and August 2020 in two French university hospitals. All charts were reviewed to identify patient characteristics, preoperative and postoperative anatomical findings, complications, and postoperative fertility and symptoms. Patients who had undergone this procedure were asked to complete a telephone questionnaire about their treatment satisfaction and symptoms. RESULTS The isthmocele was discovered most often as a result of subfertility (57.6%), but also ectopic pregnancy (18.2%), pelvic pain (15.2%), and postmenstrual bleeding (9.1%). Robot-assisted repair of the isthmocele significantly improved myometrial thickness (from 1.55 mm before surgery to 4.26 mm after surgery [mean difference 2.71; 95% confidence interval, 1.91-3.51], P = 0.0005). Among 20 patients who still desired a child after surgery, 15 became pregnant and 14 had full-term live births. Among the nine patients who had surgery for disabling symptoms, five had no persistent symptoms, three reported global improvement, and one had the same gynecologic discomfort. Seventeen patients agreed to complete the questionnaires (51.5%), and all stated that they would choose to have this surgery again. CONCLUSION Robot-assisted repair of an isthmocele is a viable minimally invasive procedure.
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Affiliation(s)
- Claire Cardaillac
- Department of Obstetrics and Gynecology and Reproductive Medicine, Nantes University Hospital, Nantes, France
| | - Caroline Salmon
- Department of Obstetrics and Gynecology, Cholet Hospital, Cholet, France
| | - Edouard Vaucel
- Department of Obstetrics and Gynecology and Reproductive Medicine, Nantes University Hospital, Nantes, France
| | - Pauline Gueudry
- Department of Obstetrics and Gynecology and Reproductive Medicine, Nantes University Hospital, Nantes, France
| | - Vincent Lavoue
- Department of Obstetrics and Gynecology, Rennes University Hospital, Rennes, France
| | | | - Thibault Thubert
- Department of Obstetrics and Gynecology and Reproductive Medicine, Nantes University Hospital, Nantes, France.,Nantes University, CHU Nantes, Movement-interaction-Performance, Nantes, France.,INSERM, CHU de Nantes, Nantes, France
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Sun W, Gao J, Fei X, Jin X, Li D. Trophoblastic microcirculation occlusion as an adjunct to electric vacuum aspiration for the treatment of endogenous cesarean scar pregnancy. Fertil Steril 2023; 119:146-150. [PMID: 36456211 DOI: 10.1016/j.fertnstert.2022.10.009] [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: 04/22/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe a simple adjunct treatment option, trophoblastic microcirculation occlusion (TMO), which could change subsequent high-risk electric vacuum aspiration in patients with an endogenous cesarean scar pregnancy (CSP) into a routine conventional surgical procedure. Electric vacuum aspiration for the treatment of CSP may be associated with several significant complications, including hemorrhage and tissue remnants. Consequently, a second intervention, such as uterine artery embolization, resectoscopy, or methotrexate, may be required, thus complicating the surgical treatment of CSP. DESIGN We demonstrate the principle and detailed technique of TMO treatment using animations, video clips, and slides. The study was approved by the institutional review board of Hangzhou Women's Hospital. SETTING Tertiary maternity hospital. PATIENT(S) The video shows a 30-year-old woman with a 5-week endogenous CSP. The procedural steps were repeated in another 6 patients suffering from endogenous CSP (Table 1). Written informed consent was obtained from each patient. INTERVENTION(S) In patients with a CSP, the syncytiotrophoblastic cells erode the helicine arteries in the inner uterine myometrium. The cytotrophoblastic cells extend as villi tissue into the syncytiotrophoblast. Maternal blood enters the intervillous space between the cytotrophoblast and syncytiotrophoblast. The syncytiotrophoblast, cytotrophoblast, and intervillous space constitute the trophoblastic microcirculation, which subsequently becomes the main blood supply to the gestational sac (Fig. 1). During TMO treatment, the trophoblastic microcirculation is identified by contrast-enhanced ultrasound with the cubital vein injected with sulfur hexafluoride microbubbles (Bracco, Switzerland). A 21-gauge needle (200 mm long) was punctured vaginally into the uterine myometrium surrounding the syncytiotrophoblast at 3 different points, and a total of 8 mL sclerosant was injected directly to seal the trophoblastic microcirculation. Complete compression of the helicine arteries for trophoblastic blood supply is the key to TMO treatment (Fig. 2, see video interpretation for detailed information). A repeat contrast-enhanced ultrasound was performed after injection to confirm a significant reduction of blood flow in the trophoblast. An electric vacuum aspiration was performed 24 hours after TMO treatment to remove the products of conception completely. Surgical safety was enhanced by deep sedation and concurrent transabdominal ultrasound guidance. The levels of β-human chorionic gonadotropin (β-hCG) were measured weekly until a nonpregnant level was achieved. A follow-up ultrasound then was performed to confirm that the treatment was complete. MAIN OUTCOME MEASURE(S) The clinical value and feasibility of TMO treatment as an adjunct before high-risk electric vacuum aspiration for the management of endogenous CSP. RESULT(S) The TMO treatment was performed successfully in all 7 patients; the clinical outcomes are presented in Table 2. The TMO treatment significantly reduced the risk of hemorrhage during electric vacuum aspiration. No complications were detected perioperatively. Patients were discharged on day 1 postoperatively. Follow-up ultrasound, performed when the levels of β-hCG had fallen to normal, failed to identify any remnants of the uterine corpus. One patient achieved an intrauterine pregnancy 7 months postoperatively and gave birth to a live baby at 39 weeks of gestation via repeat cesarean section. No cesarean scar dehiscence was observed. CONCLUSION(S) Surgical abortion of an endogenous CSP, with a high risk of intraoperative hemorrhage, can be performed with minimal blood loss in a single electric vacuum aspiration when assisted by TMO treatment. This technique provides good results in terms of bleeding reduction that are comparable to those in conventional patients. The TMO treatment can be accomplished via ultrasound-guided needle puncture, a technique that is available widely in the practice of reproductive medicine with a reduced need for consumable resources. The use of a simple adjunct treatment option, TMO, expands the indications of electric vacuum aspiration. This sequential treatment allows for completion of clinical management without the need for uterine artery embolization, resectoscopy, or methotrexate, thus simplifying the originally complicated form of surgical treatment for CSP.
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Affiliation(s)
- Wenchao Sun
- Center of Reproductive Medicine, Hangzhou Women's Hospital, Hangzhou, People's Republic of China
| | - Jiansong Gao
- Department of Ultrasound, Hangzhou Women's Hospital, Hangzhou, People's Republic of China
| | - Xiaoyang Fei
- Center of Reproductive Medicine, Hangzhou Women's Hospital, Hangzhou, People's Republic of China
| | - Xuejing Jin
- Center of Reproductive Medicine, Hangzhou Women's Hospital, Hangzhou, People's Republic of China
| | - Dingheng Li
- Department of Gynecology, Hangzhou Women's Hospital, Hangzhou, People's Republic of China.
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Zheng YJ, Chen Q, Li S, Yan XT, Zhu T, He Z. Cesarean Scar Pregnancies Treated by Uterine Artery Chemotherapy Embolization Combined With Ultrasound-Guided Dilation and Curettage: A Retrospective Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:27-33. [PMID: 35778904 DOI: 10.1002/jum.16050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 05/03/2022] [Accepted: 06/08/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To explore the effect of cesarean scar pregnancy (CSP) treatment by comparing uterine artery chemotherapy embolization (UACE) combined with dilation and curettage (D&C) with or without ultrasound guidance. METHODS CSP patients treated with UACE combined with D&C from January 2013 to December 2020 at Shuguang Hospital, affiliated to Shanghai University of Traditional Chinese Medicine were included in this retrospective study. The patients were divided into groups A and B according to whether D&C was guided by ultrasound. RESULTS Forty-eight patients with CSP diagnosed by transvaginal ultrasound were included in this study, whose gestational age was <8 weeks. There were no significant differences in the basic clinical characteristics of the two groups. The success rates of the 2 groups were no significant difference, 100% (27/27) in group A and 85.7% (18/21) in group B. The maximal intraoperative blood loss of group A was 100 mL and that of group B was 150 mL. There was no uterine perforation during the operation. Ultrasound guidance can shorten the D&C operation time, reduce intraoperative bleeding during D&C, and decrease the residual rate of trophoblastic tissue after D&C. CONCLUSIONS Ultrasound guidance can improve the safety and efficiency of UACE combined with D&C in the treatment of CSP and reduce its complications. We believe it is an optimal treatment for CSP patients who do not plan to have children in the future.
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Affiliation(s)
- Yi-Jun Zheng
- Department of Ultrasound, Shuguang Hospital affiliated to Shanghai Universtity of Traditional Chinese Medicine, Shanghai, China
| | - Qing Chen
- Department of Ultrasound, Shuguang Hospital affiliated to Shanghai Universtity of Traditional Chinese Medicine, Shanghai, China
| | - Sheng Li
- Department of Ultrasound, Shuguang Hospital affiliated to Shanghai Universtity of Traditional Chinese Medicine, Shanghai, China
| | - Xiao-Tong Yan
- Department of Gynecology, Shuguang Hospital affiliated to Shanghai Universtity of Traditional Chinese Medicine, Shanghai, China
| | - Ting Zhu
- Department of Gynecology, Shuguang Hospital affiliated to Shanghai Universtity of Traditional Chinese Medicine, Shanghai, China
| | - Zheng He
- Department of Ultrasound, Shuguang Hospital affiliated to Shanghai Universtity of Traditional Chinese Medicine, Shanghai, China
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Peng Y, Dai Y, Yu G, Jin P. Analysis of the type of cesarean scar pregnancy impacted on the effectiveness and safety of high intensity focused ultrasound combined with ultrasound-guided suction curettage treatment. Int J Hyperthermia 2022; 39:1449-1457. [DOI: 10.1080/02656736.2022.2107715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Yan Peng
- Department of Gynecology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Yu Dai
- Department of Gynecology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Guiyuan Yu
- Department of Gynecology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Ping Jin
- Department of Gynecology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
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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]
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Carbetocin Controls Intraoperative Blood Loss and Thickness of Myometrium in Scar Uterus Cases. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:5477432. [PMID: 36248432 PMCID: PMC9553459 DOI: 10.1155/2022/5477432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/11/2022] [Accepted: 09/19/2022] [Indexed: 11/05/2022]
Abstract
Objective To study the effect of carbetocin on intraoperative blood loss and thickness of myometrium during cesarean section with the scarred uterus at term pregnancy. Methods Pregnant women with full-term gestational scar uterus who underwent cesarean section from March 1, 2021, to April 30, 2022, were retrospectively collected and divided into a reference group (using oxytocin) or a study group (using carbetocin). The clinical data of the two groups were retrospectively analyzed, and the operation time, intraoperative blood loss, hospital stay, uterine contraction effect, changes in the myometrium, and complications were compared between the two groups. Results A total of 103 pregnant women were retrieved. There were 44 cases in the reference group and 59 cases in the study group. There were significant differences in operation time, intraoperative bleeding, hospital stay, postoperative adverse events, uterine fundus wall thickness, anterior wall thickness, posterior wall thickness, and uterine contraction effect between the two groups (p=0.0001, 0.005, 0.006, 0.001, 0.0004, 0.003, 0.001, and 0.005, respectively). There were no significant differences in estradiol (E2), luteinizing hormone (LH), or follicle-stimulating hormone (FSH) between the two groups before the surgery (p=0.596, 0.840, and 0.940, respectively), but there were significant differences after the surgery (p=0.011, 0.001, and 0.005, respectively). Conclusion The use of carbetocin in the cesarean section of a full-term scar uterus is significantly effective in shortening the operation time, reducing the amount of intraoperative blood loss, and promoting the recovery of the uterus.
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Liu T, Xu X. Comparison of efficacies between ultrasound-guided curettage combined with hysteroscopic electro-resection after injection of pituitrin and hysteroscopic electro-resection after methotrexate chemotherapy in the treatment of cesarean scar pregnancy. J OBSTET GYNAECOL 2022; 42:3041-3047. [PMID: 35672873 DOI: 10.1080/01443615.2022.2081793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
To compare the efficacies between ultrasound-guided curettage combined with hysteroscopic electro-resection after injection of pituitrin and hysteroscopic electro-resection after methotrexate chemotherapy in the treatment of caesarean scar pregnancy (CSP). 60 patients with CSP admitted to our hospital were selected as the study subjects, and divided into observation group (n = 35) and control group (n = 25) in accordance with the therapeutic options. The observation group was treated with ultrasound-guided curettage combined with hysteroscopic electro-resection after injection of pituitrin, while the control group was treated with hysteroscopic electro-resection after methotrexate chemotherapy. The observation group was superior to the control group in the amount of intraoperative haemorrhage, in-hospital costs, and postoperative time to control vaginal haemorrhage, time to return to a normal serum human chorionic gonadotropin (HCG) level. The observation group had a lower incidence rate of adverse reactions (5.71% vs. 28.00%, p < .05) and a higher first-attempt success rate for treatment (85.71% vs. 84.00%, p > .05) compared with the control group. Ultrasound-guided curettage combined with hysteroscopic electro-resection after injection of pituitrin, exhibiting a higher efficacy, can more effectively shorten the postoperative recovery, reduce adverse reactions, and improve the postoperative quality of life in patients with CSP. IMPACT STATEMENTWhat is already known on this subject? Caesarean scar pregnancy (CSP), a rare form of ectopic pregnancy where the fertilised egg is implanted in the muscle or fibrous tissue of the scar after a previous caesarean section (CS), is a long-term complication of CS that may be life-threatening for parturients. Some therapies have been used to treat CSP, such as uterine artery embolisation and uterine artery embolisation chemotherapy combined with curettage, but the potential adverse effects may affect the ovarian reserve and even affecting the fertility of patients.What do the results of this study add? This study showed that ultrasound-guided curettage combined with hysteroscopic electro-resection after injection of pituitrin, exhibiting a higher efficacy, can more effectively shorten the postoperative recovery, reduce adverse reactions, and improve the postoperative quality of life in patients with CSP.What are the implications of these findings for clinical practice and/or further research? The findings of this study may provide some references for the clinical practitioners and further research and may contribute to the treatment of CSP.
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Affiliation(s)
- Ting Liu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Xiaoqin Xu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
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Russo J, Harken T. Abortion and Abnormal Implantation. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2022.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jennefer Russo
- Department of Obstetrics and Gynecology, University of California–Los Angeles, Los Angeles, California, USA
- Planned Parenthood of the Pacific Southwest, San Diego, California, USA
| | - Tabetha Harken
- Department of Obstetrics and Gynecology, University of California–Irvine, Irvine, California, USA
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Gao L, Chen H, Liu J, Wang M, Lin F, Yang G, Lash GE, Li P. Extravillous trophoblast invasion and decidualization in cesarean scar pregnancies. Acta Obstet Gynecol Scand 2022; 101:1120-1128. [PMID: 35924378 PMCID: PMC9812109 DOI: 10.1111/aogs.14435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/03/2022] [Accepted: 07/09/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The increasing cesarean section rate has led to an increase in the number of subsequent pregnancies resulting in a cesarean scar pregnancy. There appears to be preferential attachment of the blastocyst to the scar site, which may be associated with defective decidua in that region, resulting in abnormal implantation, which can in turn negatively affect the success of the pregnancy. The aim of the current study was to evaluate the extravillous trophoblast, decidua, and myometrium in scar and adjacent non-scar regions of the implantation site of a cesarean scar pregnancy. MATERIAL AND METHODS Samples containing a gestational mass were obtained by laparoscopic excision from patients with a cesarean scar pregnancy at 6-11 weeks of gestation as diagnosed by transvaginal or transabdominal ultrasound (n = 8 type II cesarean scar pregnancy). Cesarean scar pregnancy tissues were separated into scar and non-scar regions, and the scar regions were sub-separated into non-implantation and implantation sites. Serial sections were histologically examined after hematoxylin and eosin, Masson's trichrome and immunochemical staining, and changes in the myometrium, extravillous trophoblast, and decidua were evaluated. RESULTS In cesarean scar pregnancy, compared with scars not in the implantation site, scars in the implantation site displayed increased fibrosis, and had disrupted myometrium, which was related to varying patterns of E-cadherin expression as a response to extravillous trophoblast invasion. In addition, local decidua was found at the non-scar implantation sites, with multinucleated trophoblast giant cell accumulation and shallow invasion. These features were not evident in the scar implantation sites. CONCLUSIONS This study emphasizes that the decidua drives multinucleated trophoblast giant cell differentiation, limiting the degree of invasion. Better characterization of this differentiation process may be helpful for better management and avoidance of the consequences of cesarean scar pregnancy.
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Affiliation(s)
- Lufen Gao
- Department of Gynecology & ObstetricsThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Hui Chen
- Department of PathologyJinan University School of MedicineGuangzhouChina
| | - Jing Liu
- Department of PathologyJinan University School of MedicineGuangzhouChina
| | - Minghua Wang
- Department of Pathology, Longgang District People's HospitalThe Second Affiliated Hospital of The Chinese University of Hong KongShenzhenChina
| | - Fangfang Lin
- Department of UltrasoundThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Guang Yang
- Department of PathologyJinan University School of MedicineGuangzhouChina
| | - Gendie E. Lash
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
| | - Ping Li
- Department of PathologyJinan University School of MedicineGuangzhouChina
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Fernandez CM, Levine EM, Shashoua A, Sodini I, Duval J, Juna J. Recognition of the Type of Cesarean Scar Pregnancy in First Trimester Sonography. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2022. [DOI: 10.1177/87564793221112354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This case series is presented to illustrate the clinical value of identifying, sonographically, the type of cesarean scar ectopic pregnancy that may present, as this has become more frequently encountered. The choice of surgical treatment appears to be dependent on the sonographic typing, of this specific type of ectopic pregnancy. This case study illustrates the importance of this topic, given the rising incidence of cesarean deliveries coupled with the increase in first trimester sonograms being more commonly performed. The value of proper diagnostic detection is important, given the contemporary management of this new type of ectopic pregnancy.
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Affiliation(s)
| | - Elliot M. Levine
- Advocate Illinois Masonic Medical Center, Chicago, IL, USA
- University of Illinois at Chicago, Chicago, IL, USA
| | | | - Irma Sodini
- Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | - Jude Duval
- Advocate Illinois Masonic Medical Center, Chicago, IL, USA
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Miller R, Gyamfi-Bannerman C. Society for Maternal-Fetal Medicine Consult Series #63: Cesarean scar ectopic pregnancy. Am J Obstet Gynecol 2022; 227:B9-B20. [PMID: 35850938 DOI: 10.1016/j.ajog.2022.06.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cesarean scar ectopic pregnancy is a complication in which an early pregnancy implants in the scar from a previous cesarean delivery. This condition presents a substantial risk for severe maternal morbidity and mortality because of challenges in securing a prompt diagnosis. Ultrasound is the primary imaging modality for cesarean scar ectopic pregnancy diagnosis, although a correct and timely determination can be difficult. Surgical, medical, and minimally invasive therapies have been described for cesarean scar ectopic pregnancy management, but the optimal treatment is unknown. Patients who decline treatment of a cesarean scar ectopic pregnancy should be counseled regarding the risk for severe morbidity. The following are the Society for Maternal-Fetal Medicine recommendations: we recommend against expectant management of cesarean scar ectopic pregnancy (GRADE 1B); we suggest that operative resection (with transvaginal or laparoscopic approaches when possible) or ultrasound-guided uterine aspiration be considered for the surgical management of cesarean scar ectopic pregnancy and that sharp curettage alone be avoided (GRADE 2C); we suggest intragestational methotrexate for the medical treatment of cesarean scar ectopic pregnancy, with or without other treatment modalities (GRADE 2C); we recommend that systemic methotrexate alone not be used to treat cesarean scar ectopic pregnancy (GRADE 1C); in patients who choose expectant management and continuation of a cesarean scar ectopic pregnancy, we recommend repeated cesarean delivery between 34 0/7 and 35 6/7 weeks of gestation (GRADE 1C); we recommend that patients with a cesarean scar ectopic pregnancy be advised on the risks of another pregnancy and counseled regarding effective contraceptive methods, including long-acting reversible contraception and permanent contraception (GRADE 1C).
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43
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Rudaitis V, Maldutytė G, Brazauskienė J, Pavlauskas M, Valančienė D. Caesarean Scar Pregnancy: A Case Report. Acta Med Litu 2022; 29:124-130. [PMID: 36061932 PMCID: PMC9428636 DOI: 10.15388/amed.2022.29.1.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/24/2022] [Accepted: 05/31/2022] [Indexed: 11/26/2022] Open
Abstract
Caesarean scar pregnancy is a potentially life-threatening gynaecological condition, becoming more common due to steadily increasing rate of caesarean sections worldwide. More than one-third of women presenting with caesarean scar pregnancy are asymptomatic, but over the time if left untreated this condition can lead to the uterine rupture and massive maternal haemorrhage. Therefore it is necessary to diagnose and manage caesarean scar pregnancies properly at the beginning of the first trimester. We present the case of woman with three previous caesarean sections, who was diagnosed with complicated caesarean scar pregnancy and then successfully managed using surgical intervention.
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Conservative Management of Cesarean Scar Pregnancy: A Case Report and Literature Review. Case Rep Obstet Gynecol 2022; 2022:1793943. [PMID: 35783220 PMCID: PMC9242790 DOI: 10.1155/2022/1793943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 06/02/2022] [Indexed: 11/18/2022] Open
Abstract
Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy located in the lower uterine segment. The current increase in the percentage of cesarean sections is accompanied by significant growth in the incidence of CSP, while advances in ultrasound diagnostic techniques have led to a greater number of CSP diagnoses. A misdiagnosed CSP, or one that is diagnosed too late, is life-threatening to the pregnant patient and predisposes her to complications such as uterine bleeding or rupture, which often require hysterectomy and thus result in the irreversible loss of fertility. We present the case of a 50-year-old woman with a history of undiagnosed CSP after multiple consultations for intermittent bleeding and hemorrhage. She was diagnosed by ultrasound and the diagnosis was confirmed by hysteroscopy. She underwent conservative medical treatment that was successful.
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Zhou W, Feng X, Yu J, Chai Z, Zheng L, Qi F. The efficacy of different treatments for type 2 cesarean scar pregnancy. Fertil Steril 2022; 118:407-413. [PMID: 35691718 DOI: 10.1016/j.fertnstert.2022.04.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To study the efficacy of 3 treatment options for type 2 cesarean scar pregnancy (CSP) and establish an optimal treatment strategy for type 2 CSP. DESIGN Retrospective cohort study. SETTING A tertiary hospital. PATIENTS The study examined 160 women with type 2 CSP. INTERVENTIONS Ultrasound-guided vacuum aspiration after local injection of lauromacrogol, ultrasound-guided vacuum aspiration after uterine artery embolization (UAE), and transabdominal resection or hysteroscopy combined with laparoscopic resection. MAIN OUTCOME MEASURES The success rates, duration of hospitalization, hospitalization cost, amount of blood loss, recovery time, and menstruation resuming after recovery. RESULTS The success rates of the UAE, lauromacrogol, and surgical groups were 87.1%, 92.5%, and 95.5%, respectively, with no significant differences. The cost and duration of hospitalization in the lauromacrogol group were significantly lower than those in the UAE and surgical groups. Analysis of the causes of treatment failure revealed a significant difference in the gestational age. The area under the receiver operating characteristic curve was 0.660 (95% confidence interval, 0.533-0.788). When the gestational age was 48.5 days, Youden index was the highest. Furthermore, when the diagnostic thresholds were selected as 49, 56, and 63 days of pregnancy, the corresponding areas under the receiver operating characteristic curve were 0.652, 0.541, and 0.510, respectively. CONCLUSION Ultrasound-guided vacuum aspiration after local injection of lauromacrogol is recommended for patients with type 2 CSP at <49 days of gestation. Laparotomy or laparoscopy combined with hysteroscopy is suitable for patients with gestation of >49 days, especially for those with >56 days of gestation.
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Affiliation(s)
- Wei Zhou
- Department of Gynecology and Obstetrics, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai, Zhejiang Province, People's Republic of China
| | - Xingjun Feng
- Department of Gynecology and Obstetrics, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai, Zhejiang Province, People's Republic of China
| | - Jiazheng Yu
- Department of Gynecology and Obstetrics, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai, Zhejiang Province, People's Republic of China
| | - Zeying Chai
- Department of Gynecology and Obstetrics, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai, Zhejiang Province, People's Republic of China
| | - Lingzhi Zheng
- Department of Gynecology and Obstetrics, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai, Zhejiang Province, People's Republic of China
| | - Feng Qi
- Department of Gynecology and Obstetrics, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai, Zhejiang Province, People's Republic of China.
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46
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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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Shi J, Ge YR, Ni J, Dong X. The Role of Transvaginal Two-Dimensional Ultrasound Combined With Color Doppler in the Evaluation of Ovarian Function and Fertility After Uterine Artery Embolization. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1575-1583. [PMID: 34609766 DOI: 10.1002/jum.15844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Our study seeks to assess the value of transvaginal two-dimensional ultrasound combined with color Doppler in evaluating ovarian function and reproductive function after uterine artery embolization (UAE). METHODS Totally 64 cases with cesarean scar pregnancy (CSP) were collected. Their information was recorded, including baseline information, intraoperative and postoperative information, preoperative and postoperative uterine receptivity, and preoperative and postoperative levels of sex hormones in serum. Finally, the patients were followed up to observe whether they were pregnant after treatment. RESULTS In comparison with 24 hours after UAE, decreases were found in endometrial blood flow pulsatility index (PI), endometrial thickness, ovarian artery peak end-systolic velocity (Vs), ovarian artery resistance index (RI), and the ratio of Vs to peak end-diastolic velocity (S/D) 1 and 3 months after embolization, while Vd increased markedly 3 months after embolization. In addition, in terms of sex hormones, a significant increase was revealed in the level of follicle-stimulating hormone, while the reduction in the levels of luteinizing hormone (LH), estrogen (E2), prolactin (PRL), and progesterone (P) in the first month and the third month of menstrual resumption compared with those before treatment. From the follow-up data, there were 50 cases of pregnancy, including 45 cases of intrauterine pregnancy, 2 cases of tubal pregnancy, and 3 cases of recurrent CSP. CONCLUSION UAE is a safe and effective method to prevent massive hemorrhage of CSP. Transvaginal two-dimensional ultrasound combined with color Doppler can more accurately evaluate its therapeutic effect and provide a basis for effective treatment.
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Affiliation(s)
- Jing Shi
- Department of Ultrasound Medicine, Guiyang Children's Hospital, Guiyang Maternal and Child Health Hospital, Guiyang, Guizhou, China
| | - Yu Rong Ge
- Department of Ultrasound Medicine, Guiyang Children's Hospital, Guiyang Maternal and Child Health Hospital, Guiyang, Guizhou, China
| | - Jiana Ni
- Department of Ultrasound Medicine, Wenzhou Central Hospital, Wenzhou, Zhejiang, China
| | - Xueqin Dong
- Department of Ultrasound Medicine, Wenzhou Central Hospital, Wenzhou, Zhejiang, China
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48
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Valasoulis G, Magaliou I, Koufidis D, Garas A, Daponte A. Caesarean Scar Pregnancy: A Case Report and a Literature Review. Medicina (B Aires) 2022; 58:medicina58060740. [PMID: 35744003 PMCID: PMC9227540 DOI: 10.3390/medicina58060740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/21/2022] [Accepted: 05/25/2022] [Indexed: 01/29/2023] Open
Abstract
Background and Objectives: Caesarean scar pregnancy (CSP) refers to placental implantation on or in the scar of a previous caesarean section and represents a potentially life-threatening condition. CSP is considered a diagnostic challenge in obstetrics, with the diagnosis relying mainly on transvaginal ultrasound (TVS) and the management depending upon case presentation and available healthcare infrastructures. Case Presentation: We present a case of 34-year-old G3P2 with a history of two-previous caesarean sections referred to the outpatient gynaecology clinic of our Department at the 7th week (7/40) of gestation with abnormal early pregnancy TVS findings, illustrating the gestational sac attached to the caesarean scar and a foetal pole with evidence of foetal cardiac activity. We discuss the outcome of an alternative combined medical and surgical approach we followed as well as an updated review of the current literature. Conclusions: The ideal management of CSP requires tertiary centers, equipment availability and experienced healthcare professionals capable of dealing with any possible complication, as well as individualized treatment based on each case presentation.
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Affiliation(s)
- George Valasoulis
- Department of Obstetrics & Gynaecology, University Hospital of Larisa, Mezourlo, 41334 Larisa, Greece; (G.V.); (I.M.); (D.K.); (A.G.)
- Hellenic National Public Health Organization-ECDC, Marousi, 15123 Athens, Greece
| | - Ioulia Magaliou
- Department of Obstetrics & Gynaecology, University Hospital of Larisa, Mezourlo, 41334 Larisa, Greece; (G.V.); (I.M.); (D.K.); (A.G.)
| | - Dimitrios Koufidis
- Department of Obstetrics & Gynaecology, University Hospital of Larisa, Mezourlo, 41334 Larisa, Greece; (G.V.); (I.M.); (D.K.); (A.G.)
| | - Antonios Garas
- Department of Obstetrics & Gynaecology, University Hospital of Larisa, Mezourlo, 41334 Larisa, Greece; (G.V.); (I.M.); (D.K.); (A.G.)
| | - Alexandros Daponte
- Department of Obstetrics & Gynaecology, University Hospital of Larisa, Mezourlo, 41334 Larisa, Greece; (G.V.); (I.M.); (D.K.); (A.G.)
- Correspondence: ; Tel.: +30-6974-368-889
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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.
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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.
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50
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Fu L, Luo Y, Huang J. Cesarean scar pregnancy with expectant management. J Obstet Gynaecol Res 2022; 48:1683-1690. [PMID: 35384174 PMCID: PMC9324103 DOI: 10.1111/jog.15258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 03/15/2022] [Accepted: 03/27/2022] [Indexed: 11/30/2022]
Abstract
Aim This study aimed to ascertain whether the lower anterior myometrial thickness (MT) between the bladder and the gestational sac in early pregnancy can be used to predict clinical outcomes in women with cesarean scar pregnancy (CSP) after expectant management. Methods We retrospectively analyzed the clinical data and early pregnancy ultrasound images of 21 patients who received expectant management for CSP. Among them, 11 patients with serious complications during pregnancy, such as intraoperative blood loss ≥1000 mL or with severe forms of morbidly adherent placenta (MAP; placenta increta or placenta percreta), were assigned to group A. The remaining 10 patients without serious complications during pregnancy were assigned to group B. The difference in MT between groups A and B was analyzed using nonparametric Mann–Whitney U test. Results There was a statistically significant difference in MT between the groups (U = 20.000, p = 0.013). The area under the receiver operating characteristics (ROC) curve was 0.818, and the optimal cut‐off value for MT was 3.3 mm. Conclusion Lower anterior MT around the gestational sac was correlated with severe complications, such as massive intraoperative bleeding or severe forms of MAP in patients with CSP.
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Affiliation(s)
- Liye Fu
- Department of Medical Imaging, Medical College of Yangtze University, Jingzhou, Hubei, China.,Department of Ultrasonography, Changsha Hospital for Maternal and Child Health Care, Changsha, Hunan, China
| | - Yingchun Luo
- Department of Ultrasonography, Maternal and Child Health Hospital of Hunan Province, Changsha, Hunan, China
| | - Jinbai Huang
- Department of Medical Imaging, Medical College of Yangtze University, Jingzhou, Hubei, China.,Department of Medical Imaging, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
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