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Zhou C, Li X, Mo Y, Wei F. The value of ultrasound parameters in predicting the efficacy of transabdominal ultrasound-guided suction curettage alone in the treatment of cesarean scar pregnancy. J Obstet Gynaecol Res 2024; 50:948-954. [PMID: 38520306 DOI: 10.1111/jog.15927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE To investigate the value of ultrasound parameters in assessing the efficacy of transabdominal ultrasound (TAUS)-guided suction curettage alone for cesarean scar pregnancy (CSP). METHODS Secondary retrospective analysis of a prospective study consisted of 137 women diagnosed with CSP who were performed TAUS-guided suction curettage alone for the first time at Maternity and Child Health Care of Guangxi Zhuang Autonomous Region in China. Prior to surgery, an ultrasound examination was conducted. Based on the need for secondary intervention, the patients were categorized into failure group and success group, and the predictive factors for failure of TAUS-guided suction curettage alone were analyzed. RESULTS Multivariate logistic regression showed that maximum diameter of the gestational sac>29 mm (odds ratio [OR] = 4.043, 95% CI: 1.100-14.862), residual myometrium thickness ≤1.8 mm (OR = 3.719, 95% CI: 1.148-12.048) and chorionic villi thickness at the scar >4.7 mm (OR = 15.327, 95% CI: 4.617-50.881) were independent predictors of failure in TAUS-guided suction curettage alone for CSP. Furthermore, the logistic regression model that was jointly constructed by these three predictors demonstrated an area under the curve, sensitivity, specificity, and Youden index of 0.913, 0.912, 0.864, and 0.776, respectively. CONCLUSION The maximum diameter of the gestational sac, residual myometrium thickness, and chorionic villi thickness at the scar has certain predictive efficacy of TAUS-guided suction curettage alone for CSP. Nevertheless, it is more valuable to apply the model of this study, composed of the three ultrasound parameters, for this prediction purpose.
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Affiliation(s)
- Chunqiao Zhou
- Department of Ultrasonography, Maternity and Child Health Care of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Xinyan Li
- Department of Ultrasonography, Maternity and Child Health Care of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yu'ning Mo
- Department of Ultrasonography, Maternity and Child Health Care of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Fangtao Wei
- Department of Ultrasonography, Maternity and Child Health Care of Guangxi Zhuang Autonomous Region, Nanning, China
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2
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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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Al-Bataineh R, Rawashdeh S, Lataifeh LN, Alzghoul SM, Al Sharie AH, Obeidat R, Altal OF. Cesarean scar ectopic partial molar pregnancy: A case report and a review of literature. Case Rep Womens Health 2023; 39:e00555. [PMID: 37868260 PMCID: PMC10587699 DOI: 10.1016/j.crwh.2023.e00555] [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: 09/10/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023] Open
Abstract
A scar ectopic pregnancy exhibiting hydatidiform features is an extremely rare and clinically challenging entity. Delayed diagnosis and failure to treat such cases promptly can lead to devastating consequences. In this report, we present a case of cesarean scar ectopic partial molar pregnancy in a 37-year-old woman who presented with complaints of vaginal discharge with streaks of blood and lower abdominal pain. Diagnostic laparoscopy revealed an abnormal mass of brown soft tissue in the anterior wall of the uterus, measuring 13.0 × 9.0 × 2.0 cm, raising suspicion (in the context of elevated serum human chorionic gonadotropin levels) of a scar ectopic pregnancy. Open laparotomy was performed, and the scar ectopic mass was successfully removed. The histologic examination of the tissue revealed a partial hydatidiform mole. The patient experienced a full recovery postoperatively, with serum human chorionic gonadotropin levels gradually declining to normal values. This report is unique in its presentation of the clinicopathological features of cesarean scar ectopic molar pregnancy and the successful management of the condition.
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Affiliation(s)
- Rania Al-Bataineh
- Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | | | - Leen N. Lataifeh
- Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Saja M. Alzghoul
- Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Ahmed H. Al Sharie
- Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Rawan Obeidat
- Department of Obstetrics & Gynecology, Faculty of Medicine, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid 22110, Jordan
| | - Omar F. Altal
- Department of Obstetrics & Gynecology, Faculty of Medicine, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid 22110, Jordan
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Knapman BL, Forgues MAS, Abbott JA, Maheux-Lacroix S. Other treatments for CSP. Best Pract Res Clin Obstet Gynaecol 2023; 90:102367. [PMID: 37379723 DOI: 10.1016/j.bpobgyn.2023.102367] [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: 04/01/2023] [Revised: 05/20/2023] [Accepted: 05/30/2023] [Indexed: 06/30/2023]
Abstract
Caesarean scar pregnancy (CSP) is an increasingly common clinical conundrum. The non-curettage surgical management of CSP can be categorised into hysteroscopic, vaginal, laparoscopic, and open removal modalities and the choice of treatment is surgeon-dependent. A systematic review of original studies reporting surgical treatment outcomes of CSP until March 2023 was conducted to evaluate the non-curettage surgical management of this highly morbid condition. A total of 60 studies of mostly weak methodological quality were identified involving 6720 CSP cases. Success rates were generally high across all treatment modalities although highest in vaginal and laparoscopic excisional approaches. Morbidity was most associated with haemorrhage although unplanned hysterectomy rates remained low across all treatment groups. Subsequent pregnancies are associated with morbidity despite being underreported and the impact of CSP treatment on future pregnancy is poorly understood. Substantive study heterogeneity precludes meta-analyses of pooled data and treatment superiority has not been demonstrated.
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Affiliation(s)
- Blake L Knapman
- School of Clinical Medicine, UNSW Sydney, NSW, 2031, Australia; Gynaecological Research and Clinical Evaluation (GRACE) Unit, The Royal Hospital for Women, Barker Street, Randwick, NSW, 2031, Australia.
| | | | - Jason A Abbott
- School of Clinical Medicine, UNSW Sydney, NSW, 2031, Australia; Gynaecological Research and Clinical Evaluation (GRACE) Unit, The Royal Hospital for Women, Barker Street, Randwick, NSW, 2031, Australia.
| | - Sarah Maheux-Lacroix
- Gynaecological Research and Clinical Evaluation (GRACE) Unit, The Royal Hospital for Women, Barker Street, Randwick, NSW, 2031, Australia; CHU de Quebec, Université Laval, 2705 Boul. Laurier, Quebec, QC, G1V 0A6, Canada.
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Zeng S, Wang Y, Ye P, Xu L, Han W, Li F, Tang C, Zhou J, Xie X. Comparing the clinical efficacy of three surgical methods for cesarean scar pregnancy. BMC Womens Health 2023; 23:271. [PMID: 37198658 DOI: 10.1186/s12905-023-02415-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/05/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND We aimed to compare the clinical efficacy of three surgical methods in the treatment of various types of cesarean scar pregnancy (CSP). METHODS Herein, 314 cases of CSP were treated in the department of Obstetrics and Gynecology of the First Affiliated Hospital of Gannan Medical University between June 2017 and June 2020. The patients were divided into three groups based on the treatment received: group A (n = 146; curettage by pituitrin combined with ultrasonic monitoring and hysteroscopy-guided surgery), group B [n = 90; curettage after methotrexate (MTX) injection into the local gestational sac], and group C (n = 78; laparoscopic, transvaginal, and transabdominal cesarean scar resection). These groups were divided into three subgroups (type I, type II, and type III) according to the CSP type of the patients. RESULTS The intraoperative blood loss, length of hospital stay, hospitalization cost, menstrual recovery time, and serum β-HCG normalization time were lower in groups A than in groups B or C with type I, II and III CSP (P < 0.05). Operative efficiency and Successful second pregnancy rate were higher in groups A than in groups B or C with type I and II CSP (P < 0.05). But in type III CSP, the complications were more serious in group A than group C. CONCLUSIONS Curettage by pituitrin combined with ultrasonic monitoring and hysteroscopy-guided surgery is an effective and relatively safe treatment for patients with type I and II CSP. Laparoscopic surgery is more suitable for type III CSP.
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Affiliation(s)
- Shaoying Zeng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, 510630, Guangzhou, Guangdong, China
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Gannan Medical University, 34100, Ganzhou, Jiangxi, China
| | - Yang Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Gannan Medical University, 34100, Ganzhou, Jiangxi, China
| | - Ping Ye
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Gannan Medical University, 34100, Ganzhou, Jiangxi, China
| | - Ling Xu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Gannan Medical University, 34100, Ganzhou, Jiangxi, China
| | - WenLing Han
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Gannan Medical University, 34100, Ganzhou, Jiangxi, China
| | - Feng Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Gannan Medical University, 34100, Ganzhou, Jiangxi, China
| | - Chen Tang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Gannan Medical University, 34100, Ganzhou, Jiangxi, China
| | - Jieli Zhou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Gannan Medical University, 34100, Ganzhou, Jiangxi, China
| | - Xiaoying Xie
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Gannan Medical University, 34100, Ganzhou, Jiangxi, China.
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Gannan Medical University, No.128 Jin Ling Road, Ganzhou, Jiangxi, 34100, China.
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Cetin F, Kayar İ, Serin AN, Birge Ö. Efficacy of suction curettage as the first-line treatment of cesarean scar pregnancy: A retrospective study. J Gynecol Obstet Hum Reprod 2023; 52:102531. [PMID: 36592889 DOI: 10.1016/j.jogoh.2022.102531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/03/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE There is still no consensus on a safe and efficient treatment modality for cesarean scar pregnancy (CSP), which is known to cause severe complications, such as life-threatening hemorrhage. Suction curettage (SC) has been used as the first-line treatment for CSP with controversial outcomes. In this context, the objective of this study is to analyze the efficacy of SC in the treatment of CSP. METHODS The sample of this retrospective study consisted of 64 CSP patients treated using SC between 2012 and 2022. Patients' demographic and clinical variables, including the thickness of the myometrium at the lower uterine segment between the urinary bladder and cesarean scar, were obtained from their medical records. The study's primary outcome was determined as the success rate of SC. Accordingly, the patients were categorized into two groups: successful SC (Group 1) and unsuccessful SC (Group 2). RESULTS The success rate of SC was determined as 78.1%. The number of previous cesarean deliveries, gestational age, baseline beta-human chorionic gonadotropin (β-hCG) values, and endometrial thickness was significantly higher in Group 2 (p<0.05 for all), whereas the fetal cardiac activity and absence of an embryonic pole were significantly higher in Group 2 (p = 0.001 and p = 0.004, respectively). There was no significant difference between the groups in the thickness of the myometrium at the lower uterine segment (p = 0.890). The hemoglobin levels decreased significantly after SC in both Groups 1 and 2 (p<0.001 and p = 0.009, respectively). There was no significant difference between the groups in preoperative and postoperative hemoglobin values and the decrease in hemoglobin levels (p>0.05). CONCLUSION The study findings did not indicate any significant correlation between myometrial thickness at the lower uterine segment and the efficacy of SC in CSP patients. On the other hand, the number of cesarean deliveries, gestational age, baseline β-hCG values, endometrium thickness, fetal cardiac activity, and embryonic pole may be used to predict the outcome of SC in the treatment of CSP.
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Affiliation(s)
- Ferhat Cetin
- Department of Gynecology and Obstetrics, Osmaniye Private Park Hospital, Osmaniye, Turkey
| | - İlkan Kayar
- Department of Gynecology and Obstetrics, Osmaniye State Hospital, Osmaniye, Turkey.
| | - Aliye Nigar Serin
- Department of Gynecology and Obstetrics, Faculty of Medicine, Karamanoglu Mehmetbey University, Karaman, Turkey
| | - Özer Birge
- Department of Gynecology and Obstetrics, Ordu Training and Research Hospital, Ordu, Turkey
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7
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Fu P, Zhou T, Cui P, Wang W, Wang S, Liu R. Selection of Laparoscopy or Laparotomy for Treating Cesarean Scar Pregnancy: A Retrospective Study. Int J Gen Med 2022; 15:7229-7240. [PMID: 36124106 PMCID: PMC9482461 DOI: 10.2147/ijgm.s369884] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/07/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Methods Results Conclusion
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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, People’s Republic of China
| | - Ting Zhou
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Pengfei Cui
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Wenwen Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Shixuan Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Ronghua Liu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
- Correspondence: Ronghua Liu, Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Anv, Wuhan, Hubei, 430030, People’s Republic of China, Tel/Fax +86 27 83663078, Email
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Li J, Li H, Jiang J, Zhang X, Shan S, Zhao X, Shi B. Dilatation and curettage versus lesion resection in the treatment of cesarean-scar-pregnancy: A systematic review and meta-analysis. Taiwan J Obstet Gynecol 2021; 60:412-421. [PMID: 33966722 DOI: 10.1016/j.tjog.2021.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2020] [Indexed: 11/18/2022] Open
Abstract
This meta-analysis was performed to compare the efficacy and safety of dilatation and curettage (D&C) (simply D&C or combined with other treatments) and lesion resection for cesarean scar pregnancy (CSP). A search of English and Chinese databases from 2010 to 2019 was conducted. Thirty one studies were retrieved including sixteen random controlled and fifteen case controlled trials. Compared with abdominal resection surgery(ARS) and vaginal resection surgery(VRS), uterine artery embolization(UAE)+D&C has no obvious difference in curative effect and safety (UAE + D&C versus ARS: Cure rate(CR): P = 0.076, time for menstruation recovery/β-HCG normalization: P = 0.545/0.949,Blood loss: P = 0.005, adverse event: P = 0.420; versus VRS: CR: P = 0.085, time for menstruation recovery/β-HCG normalization: P < 0.001/P = 0.031,Blood loss: P = 0.902, adverse event: P = 0.249). UAE + D&C associated with lower blood loss and less postoperative complication than laparoscopic resection surgery(LRS), but LRS take more advantages in terms of the curative effect (CR: P = 0.047, time for menstruation recovery/β-HCG normalization: P = 0.352/0.103). The efficacy and safety of VRS are better than D&C, methotrexate (MTX) + D&C (D&C versus VRS: CR: P < 0.001, time for β-HCG normalization: P = 0.363,blood loss: P < 0.001, adverse event: P = 0.046; MTX + D&C versus VRS: CR: P < 0.001, time for menstruation recovery/β-HCG normalization: P < 0.001/P = 0.005, blood loss: P < 0.001, adverse event: P < 0.001). Lesion resection had advantages in shorter time for menstrual recovery/β-HCG normalization and less adverse events, lower failure rate over the administration of D&C treatments. In detail, the curative effect of UAE + D&C is similar to ARS and VRS, but inferior to LRS, while the safety of UAE + D&C is better than LRS. The efficacy and safety of simply D&C and MTX + D&C are not as good as VRS.
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Affiliation(s)
- Jiajia Li
- Department of Obstetics & Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Hongye Li
- Department of Obstetics & Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jing Jiang
- Department of Obstetics & Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
| | - Xiaolin Zhang
- Epidemiological and Health Statistics, Hebei Medical University, Shijiazhuang, Hebei, China.
| | - Shuzhi Shan
- Department of Obstetics & Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xin Zhao
- Department of Obstetics & Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Bin Shi
- Department of Obstetics & Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Bağlı İ, Bakır MS, Doğan Y, Erdem S, Taşın C, Demirel NU, Kulahçıoğlu Mİ. Is suction curettage an effective treatment alternative for cesarean scar pregnancies? Eur J Obstet Gynecol Reprod Biol 2021; 258:193-197. [PMID: 33450710 DOI: 10.1016/j.ejogrb.2021.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/19/2020] [Accepted: 01/02/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The study aims to evaluate the success rate of suction curettage (SC) as a first line treatment with or without use of foley balloon tamponade for cesarean scar pregnancy (CSP) and to determine the risk factors for failure of treatment. STUDY DESIGN The study was retrospective and included 36 CSP cases who underwent SC for treatment. Presence of pain with active bleeding and > 10 weeks of gestation were taken as the exclusion criterion. The procedure was performed under sonographic guidance. After the procedure, in patients who had a hemorrhage foley catheter was inserted into the uterine cavity. SC failure was defined as a requirement of secondary intervention. CSP types, myometrial thickness in the scar area, fetal cardiac activity, initial Beta human chorionic gonadotropin levels (β-HCG), history of vaginal delivery were compared between successful and failed groups. RESULT Of 36 patients, 31 had favorable results with SC ± foley balloon tamponade. Success rate was found to be 86 % (31/36) as the first line therapy. Foley catheter was applied for 23 patients, among them, four were in the failed group and 19 were in the favorable group. In the failed group, two patients had emergent laparotomy, two had repeat SC the day after the initial treatment and one patient was treated with systemic MTX. Fetal cardiac activity and presence of embryonic pole were not different between the groups (p = 1.000, p = 0.829 respectively). Myometrial thickness in the failed group was less than the successful group, this difference was significant (p = 0.033). CSP types, initial β-HCG levels and history of vaginal delivery were not different between the groups (p = 0.149, p = 0.372 and p = 0.404 respectively). CONCLUSION SC may be considered as a first line therapy for CSPs, and and in patients complicated with hemorrhage foley balloon tamponade can be used easily. Thinner myometrium at previous cesarean scar can be considered as a risk factor for failure of SC in patients with CSP.
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Affiliation(s)
- İhsan Bağlı
- University of Health Sciences Diyarbakir Gazi Yasargil Research and Training Hospital, Department of Obstetrics and Gynecology, Diyarbakır, Turkey.
| | - Mehmet Sait Bakır
- University of Health Sciences Diyarbakir Gazi Yasargil Research and Training Hospital, Department of Obstetrics and Gynecology, Diyarbakır, Turkey
| | - Yasemin Doğan
- University of Health Sciences Diyarbakir Gazi Yasargil Research and Training Hospital, Department of Obstetrics and Gynecology, Diyarbakır, Turkey
| | - Selami Erdem
- University of Health Sciences Diyarbakir Gazi Yasargil Research and Training Hospital, Department of Obstetrics and Gynecology, Diyarbakır, Turkey
| | - Cuma Taşın
- Mersin University, Department of Obstetrics and Gynecology, Mersin, Turkey
| | - Neslihan Uğur Demirel
- University of Health Sciences Diyarbakir Gazi Yasargil Research and Training Hospital, Department of Obstetrics and Gynecology, Diyarbakır, Turkey
| | - Mehmet İrfan Kulahçıoğlu
- University of Health Sciences Diyarbakir Gazi Yasargil Research and Training Hospital, Department of Obstetrics and Gynecology, Diyarbakır, Turkey
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10
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Xu X, Li D, Yang L, Jing X, Kong X, Chen D, Ru T, Zhou H. Surgical outcomes of cesarean scar pregnancy: an 8-year experience at a single institution. Arch Gynecol Obstet 2021; 303:1223-1233. [PMID: 33389114 DOI: 10.1007/s00404-020-05906-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 11/17/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To summarize the outcomes of different surgical treatment modalities for cesarean scar pregnancy (CSP) at a single institution over 8 years. METHODS A case series of patients diagnosed with CSP who were admitted to Nanjing Drum Tower Hospital from January 2011 to December 2018 was retrospectively studied. Medical records of all the patients were carefully reviewed. Data on patient demographics, pregnancy characteristics, treatment modalities, response to therapy, and subsequent pregnancy outcomes were collected and analyzed. RESULTS A total of 117 patients undergoing surgical treatments for CSP were included. Thirty-three patients (28.21%) underwent ultrasound-guided curettage; while, 74 (63.25%) and 10 (8.55%) patients received laparoscopy-monitored curettage and laparoscopic CSP resection, respectively. Most of the patients (21/33) who underwent ultrasound-guided surgery had type I CSP; while, 54 out of 84 patients who opted for laparoscopic surgeries had type II CSP. Eleven women underwent a uterine artery embolization procedure before the operation. There was no difference in the use of an intrauterine balloon for hemostasis among the three groups. Only 8 patients needed additional systemic methotrexate treatment. Twenty-four out of 57 women (42.11%) succeeded in conceiving again and gave birth to 21 healthy babies. Only 1 woman (1/24, 4.17%) experienced recurrence of CSP. CONCLUSIONS These data indicated the safety and efficiency of ultrasound-guided curettage, laparoscopy-monitored curettage, and laparoscopic CSP resection for the treatment of CSP.
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Affiliation(s)
- Xiaofeng Xu
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, People's Republic of China
| | - Dongdong Li
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, People's Republic of China
| | - Lan Yang
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, People's Republic of China
| | - Xiujuan Jing
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, People's Republic of China
| | - Xiangyi Kong
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, People's Republic of China
| | - Dezhu Chen
- Department of Nuclear Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, People's Republic of China
| | - Tong Ru
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, People's Republic of China
| | - Huaijun Zhou
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, People's Republic of China.
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Altay MM, Mert SA, Gemici A, Kaplan M, Gelisen O. Successful technique of manual vacuum aspiration for treatment of type 2 cesarean scar pregnancies: evaluation of 40 cases. J Matern Fetal Neonatal Med 2019; 34:2693-2700. [PMID: 31575309 DOI: 10.1080/14767058.2019.1670807] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To demonstrate the effectiveness and safety of the defined manual vacuum aspiration (MVA) technique for treatment of type 2 cesarean scar pregnancies (CSPs). METHODS We treated 40 patients with CSP by MVA at the Early Pregnancy Clinic of our hospital between 1 January 2012 and 31 December 2014. The files of patients were reviewed and evaluated retrospectively. Eligibility criteria were hemodynamic stability and at least 2 mm myometrial thickness at the anterior part of the CSP. The key-point of successful MVA procedure is to keep away from entering the cesarean scar cavity directly; instead, CSP is displaced from the implantation site by applying vacuum, only while the cannula is passing near. RESULTS During the study period, the ratio of CSP to total pregnancies was 1/1000. The ratio of CSP to cesarean delivery (CD) was 1/372. In that time period, CSPs were constituted 4.41% of all ectopic pregnancies. Total of 40 patients were treated with dilatation and MVA. Complications such as excessive hemorrhage, persistence of CSP, and any need of extra intervention were not observed. The beta-hCG values of 21 patients (52.5%) decreased below 10 mIU/mL after the first 15 days, and the rest decreased below 10 mIU/mL after 3 weeks following MVA. CONCLUSIONS This MVA technique for treatment of CSP is easily applicable and effective method with high success and low complication rates. For appropriately selected patients, we think that this method can be considered as the first- line treatment.
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Affiliation(s)
- Mehmet Metin Altay
- Etlik Zubeyde Hanım Women's Health Education and Research Hospital, Ankara, Turkey
| | - Sule Atalay Mert
- Etlik Zubeyde Hanım Women's Health Education and Research Hospital, Ankara, Turkey
| | - Ali Gemici
- Obstetrics and Gynecology, Guven Hospital, Ankara, Turkey
| | - Metin Kaplan
- Etlik Zubeyde Hanım Women's Health Education and Research Hospital, Ankara, Turkey
| | - Orhan Gelisen
- Etlik Zubeyde Hanım Women's Health Education and Research Hospital, Ankara, Turkey
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Dağdeviren EG, Dur R, Fadıloğlu E, Demirdağ E, Öztürk Ç, Altay M. Molar pregnancy in cesarean section scar: A case report. Turk J Obstet Gynecol 2017; 14:249-251. [PMID: 29379669 PMCID: PMC5780570 DOI: 10.4274/tjod.26878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 11/05/2017] [Indexed: 12/13/2022] Open
Abstract
Cesarean scar ectopic pregnancies and molar pregnancies are two very rare obstetric pathologies. In both cases, serious morbidities are involved that require careful management. The coexistence of the two clinical conditions is far less common and there are a limited number of cases in the literature. In this case report, a 34-year-old patient with previous cesarean section was diagnosed as having a molar pregnancy in a cesarean scar through ultrasonography. The patient was asymptomatic at that time. Ultrasonography revealed a protruding mass at the cesarean section and her human chorionic gonadotropin level was measured as 59.705 mIU/mL. Due to the risk of severe bleeding, cesarean section scar excision and revision were performed via laparotomy after counselling the patient. Removal of all trophoblastic tissue was observed as a result of the frozen pathology and the operation was terminated. After the definite pathology result came as a complete molar pregnancy, the patient was followed up according to molar pregnancy follow-up protocols and cured completely. Despite the alternative treatment options (methotrexate application, curettage, uterine artery embolization) in such patients, the decision for surgery was made after counselling the patient. In this very rare clinical condition, patients should be closely monitored and the appropriate treatment option should be applied as soon as possible, taking into consideration the bleeding risks of both pathologies.
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Affiliation(s)
- Elif Gülşah Dağdeviren
- University of Health Sciences, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Rıza Dur
- University of Health Sciences, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Erdem Fadıloğlu
- Kilis State Hospital, Clinic of Women’s Health, Kilis, Turkey
| | - Erhan Demirdağ
- University of Health Sciences, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Çağatayhan Öztürk
- University of Health Sciences, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Metin Altay
- TOBB University of Economics and Technology Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Women’s Health, Ankara, Turkey
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