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You X, Ruan Y, Weng S, Lin C, Gan M, Qi F. The effectiveness of hysteroscopy for the treatment of cesarean scar pregnancy: a retrospective cohort study. BMC Pregnancy Childbirth 2024; 24:151. [PMID: 38383385 PMCID: PMC10880367 DOI: 10.1186/s12884-024-06344-y] [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: 11/08/2023] [Accepted: 02/12/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Cesarean scar pregnancy (CSP) is a long-term complication of cesarean section characterized by the localization of a subsequent gestational sac within the scar area or niche developed as a result of a previous cesarean section. Its incidence has increased substantially because of the high global cesarean section rate in recent decades. Several surgical and drug treatments exist for this condition; however, there is currently no optimal treatment. This study compared the effectiveness of direct hysteroscopic removal of the gestational tissue and hysteroscopy combined with vacuum suction for the treatment of CSP. METHODS From 2017 to 2023, 521 patients were diagnosed with CSP at our hospital. Of these patients, 45 underwent hysteroscopy. Among them, 28 underwent direct hysteroscopic removal (hysteroscopic removal group) and 17 underwent hysteroscopy combined with vacuum suction (hysteroscopic suction group). The clinical characteristics and outcomes of the hysteroscopic removal group and hysteroscopic suction group were analyzed. RESULTS Among the 45 patients, the amount of bleeding and hospitalization cost were significantly higher in the hysteroscopic removal group than in the hysteroscopic suction group (33.8 mL vs. 9.9 mL, P < 0.001; and 8744.0 yuan vs. 5473.8 yuan, P < 0.001; respectively). The operation time and duration of hospitalization were significantly longer in the hysteroscopic removal group than in the hysteroscopic suction group (61.4 min vs. 28.2 min, P < 0.001; and 3.8 days vs. 2.4 days, P = 0.026; respectively). Three patients in the hysteroscopic removal group had uterine perforation and received laparoscopic repair during operation. No complications occurred in the hysteroscopic suction group. One patient in the hysteroscopic removal group received ultrasound-guided suction curettage due to postoperative moderate vaginal bleeding, and one patient in the hysteroscopic suction group received ultrasound-guided suction curettage due to postoperative gestational residue and elevated serum beta-human chorionic gonadotropin levels. Reproductive function was preserved in all patients. CONCLUSIONS Hysteroscopy is an effective method for treating CSP. Compared with direct hysteroscopic removal, hysteroscopy combined with vacuum suction is more suitable for CSP. However, multicenter prospective studies with large sample sizes are required for verification of these findings.
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Affiliation(s)
- Xinxin You
- Department of Gynecology and Obstetrics, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai, Zhejiang Province, China
| | - Yan Ruan
- Department of Gynecology and Obstetrics, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai, Zhejiang Province, China
| | - Shouxiang Weng
- Department of Gynecology and Obstetrics, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai, Zhejiang Province, China
| | - Chenya Lin
- Department of Gynecology and Obstetrics, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai, Zhejiang Province, China
| | - Meifu Gan
- Department of Gynecology and Obstetrics, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai, Zhejiang Province, China.
| | - Feng Qi
- Department of Gynecology and Obstetrics, Taizhou Hospital of Zhejiang Province, Zhejiang University, Linhai, Zhejiang Province, China.
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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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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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Huang J, He P, Li D, Zhou J. Predictive factors analysis of cesarean scar pregnancy treated by local injection of Lauromacrogol combined with curettage. Medicine (Baltimore) 2023; 102:e32783. [PMID: 36705381 PMCID: PMC9876022 DOI: 10.1097/md.0000000000032783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
To explore factors related to local injection of Lauromacrogol combined with curettage in the treatment of cesarean scar pregnancy. A total of 24 successful and 8 unsuccessful cases were included. The age, gravidity, parity, times of cesarean section, interval from the last cesarean section, preoperative human chorionic gonadotropin (HCG), HCG on the first day after operation, decreasing rate of HCG on the first day after operation, average diameter of gestational sac, and preoperative vaginal bleeding days were analyzed. There were no significant differences of age, gravidity, parity, previous cesarean section times between groups. The differences of preoperative HCG, HCG on the first day after operation, the decreasing rate of HCG, gestational sac diameter, preoperative vaginal bleeding days were statistically significant between groups. The interval from the last cesarean section and the decreasing rate of HCG were protective factors, while the mean diameter of gestational sac and period of vaginal bleeding before operation were risk factors for the success of the treatment. The mean diameter of gestational sac owned the best predictive value.
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Affiliation(s)
- Jianxia Huang
- Gynecology Department, The Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, Zhejiang, China
- * Correspondence: Jianxia Huang, Gynecology Department, The Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, Zhejiang 310000, China (e-mail: )
| | - Pei He
- Department of Obstetrics, Hangzhou Women’s Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, Zhejiang, China
| | - Dingheng Li
- Department of Gynecology, Hangzhou Women’s Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, Zhejiang, China
| | - Jianwei Zhou
- Gynecology Department, The Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, Zhejiang, China
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Ye JP, Gao Y, Lu LW, Ye YJ. Effectiveness and safety of ultrasound-guided intramuscular lauromacrogol injection combined with hysteroscopy in cervical pregnancy treatment: A case report. World J Clin Cases 2022; 10:6128-6135. [PMID: 35949833 PMCID: PMC9254199 DOI: 10.12998/wjcc.v10.i18.6128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/07/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cervical pregnancy is increasing in morbidity, and a definite diagnosis in early stages is challenging due to its specific onset site. Surgery is the mainstay of treatment for cervical pregnancy, but it may result in the loss of natural fertility. Therefore, it is a great challenge to pursue a safe and effective treatment for cervical pregnancy.
CASE SUMMARY We report the case of a cervical pregnancy successfully treated by ultrasound-guided cervical-intramuscular lauromacrogol injection combined with hysteroscopy. A 23-year-old woman with minor irregular vaginal bleeding was admitted to our department with suspected ectopic pregnancy. Transvaginal ultrasound revealed a gestational sac (approximately 22 mm x 13 mm) situated in the cervical canal with a yolk sac and blood flow signals. No cardiac activity was detected. Serum beta progesterone was 17.06 ng/mL, and serum beta human chorionic gonadotropin (β-HCG) was 5077.0 IU/L. The patient was diagnosed with cervical pregnancy. She was treated by ultrasound-guided cervical-intramuscular injections of lauromacrogol (3 mL) in combination with aborting under hysteroscopic visualization. A gradual decrease in β-HCG levels and normal ultrasound findings were observed. Postoperative pathologic examination showed the presence of villi and changes in the endometrium in the secretory phase. The patient was discharged on day 6, and her β-HCG level was 0.67 mIU/mL after 1 wk. There was no statistical difference between baseline and 1-week postoperative data in terms of serum indices including liver function, renal function, and routine blood analysis after treatment. The patient subsequently became pregnant 2 mo later and no abnormalities were detected on routine screening during pregnancy.
CONCLUSION Ultrasound-guided cervical-intramuscular lauromacrogol injection combined with hysteroscopy may be effective and safe in the treatment of cervical pregnancy.
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Affiliation(s)
- Jian-Pei Ye
- Department of Ultrasonography, Lishui Hospital of Traditional Chinese Medicine, Lishui 323000, Zhejiang Province, China
| | - Yang Gao
- Department of Gynaecology, Lishui Hospital of Traditional Chinese Medicine, Lishui 323000, Zhejiang Province, China
| | - Li-Wei Lu
- Department of Gynaecology, Lishui Hospital of Traditional Chinese Medicine, Lishui 323000, Zhejiang Province, China
| | - Yong-Ju Ye
- Department of Gynaecology, Lishui Hospital of Traditional Chinese Medicine, Lishui 323000, Zhejiang Province, China
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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: 3] [Impact Index Per Article: 1.5] [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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Treatment of Cesarean Scar Pregnancy with Traditional Chinese Medicine and Warming Moxibustion. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:5835569. [PMID: 35620401 PMCID: PMC9129969 DOI: 10.1155/2022/5835569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/13/2022] [Accepted: 04/27/2022] [Indexed: 11/17/2022]
Abstract
We aimed to report the clinical characteristics of cesarean scar pregnancy (CSP), improve the understanding of uterine scar pregnancy, and assess the outcomes of our treatment strategy for CSP. We present 30 patients with CSP diagnosed by transvaginal ultrasonography. Patients received B ultrasound-guided lauromacrogol injection, followed by evacuation under B ultrasound guidance, and intrauterine balloon compression for hemostasis. Postoperatively, all patients received Bushenquyu decoction and warming moxibustion. All patients showed fast recovery and preserved fertility. The combination of lauromacrogol injection and suction curettage under hysteroscopic guidance is an effective conservative treatment for CSP that can help preserve the reproductive function. Postoperative traditional Chinese medicine and warming moxibustion may reduce the risk of ectopic pregnancy and increase the rate of subsequent intrauterine pregnancy.
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Hong T, Chai Z, Liu M, Zheng L, Qi F. The Efficacy and Health Economics of Different Treatments for Type 1 Cesarean Scar Pregnancy. Front Pharmacol 2022; 13:822319. [PMID: 35153794 PMCID: PMC8831712 DOI: 10.3389/fphar.2022.822319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/12/2022] [Indexed: 02/03/2023] Open
Abstract
Objectives: To evaluate the efficacy and health economics of four treatments for type 1 cesarean scar pregnancy (CSP). Methods: From January 2009 to December 2018, 326 patients diagnosed with type 1 CSP were examined, among whom 31 received ultrasound-guided local injection of methotrexate (local injection group), 160 patients received uterine artery embolization combined with suction aspiration (UAE group), 25 patients received ultrasound-guided suction aspiration (aspiration group) and 90 received ultrasound-guided local injection of lauromacrogol combined with suction aspiration (lauromacrogol group). Clinical data and outcomes were analyzed. The decision tree model was used to compare the economics of four treatments. Results: The success rate of the local injection group was 71.0% (22/31), which was significantly different from 98.8% (158/160) of the UAE group and 100.0% (90/90) of the lauromacrogol group. The success rate of the aspiration group was 92.0% (23/25), which was significantly lower than that of the lauromacrogol group. The cost-effectiveness ratio was 1,876.53 yuan for the aspiration group, 2,164.63 yuan for the lauromacrogol group, 4,383.56 yuan for the local injection group, and 7,850.81 yuan for the UAE group. The Incremental cost effectiveness ratio (ICER) of the lauromacrogol group to the aspiration group was 5,477.75 yuan, indicating that if the willing to pay of patients was higher than 5,477.75 yuan, the lauromacrogol group had a cost-effectiveness advantage in treating type 1 CSP, compared to aspiration group. On the contrary, aspiration group has a higher cost-effectiveness advantage. The ICER of the lauromacrogol group to the local injection group or the UAE group were both less than 0, indicating that local injection group and UAE group was not cost-effective in the treatment of type 1 CSP. Conclusion: For type 1 CSP, the ultrasound-guided local injection of lauromacrogol combined with suction aspiration and ultrasound-guided suction aspiration, are effective and economical, and the choice between the two can be based on the patient’s willing to pay.
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Zhu L, Gao J, Yang X, Qian L, Wang Y, Zhang H, Chen B, Li D. The novel use of lauromacrogol: A respective study of ultrasound-guided sclerosant injection for cesarean scar pregnancy. J Obstet Gynaecol Res 2021; 48:140-145. [PMID: 34755427 DOI: 10.1111/jog.15080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/09/2021] [Accepted: 10/12/2021] [Indexed: 02/06/2023]
Abstract
AIM To introduce the novel use of lauromacrogol for cesarean scar pregnancy (CSP), and to compare the clinical efficacy and safety of curettage combined with ultrasound-guided sclerosant injection (USI) and curettage following uterine artery embolization (UAE) in the treatment of CSP. METHODS CSP patients undergoing curettage combined with USI (n = 72) from December 2014 to May 2020 were compared to patient with curettage following UAE (n = 72).The basic clinical findings and clinical outcomes were reviewed between the two groups. RESULTS For USI group, 69 patients underwent successful treatment (95.8% success rate), while the number of cured patients for the UAE group was 70 (97.2% success rate). Differences between USI group and UAE group in intraoperative blood loss (10.0 [10.0-20.0] vs. 10.0 [10.0-20.0] mL) and time for serum β human chorionic gonadotropin (β-hCG) to reduce to normal (28.0 [21.0-40.0] vs. 28.0 [21.0-35.0] days) were not statistically significant. The hospital stay for USI group was significantly shorter than that for UAE group (4.0 [4.0-6.0] vs. 6.0 [5.0-7.0] days, respectively). Statistically significant decreases were noted in hospitalization expenses and adverse events in USI group, compared to UAE group. There was no difference in live birth rate between the two groups with fertility intentions during the follow-up. CONCLUSION For treatment of CSP, curettage combined with USI yielded clinical results comparable to those of curettage following UAE. Curettage combined with USI was associated with lower hospitalization expenses, shorter hospital stay and less complications, and it merited an effective and safe treatment for CSP.
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Affiliation(s)
- Linling Zhu
- Department of Gynecology, Hangzhou Women's Hospital, Hangzhou, China
| | - Jiansong Gao
- Department of Ultrasound, Hangzhou Women's Hospital, Hangzhou, China
| | - Xinyun Yang
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liang Qian
- Department of Gynecology, Hangzhou Women's Hospital, Hangzhou, China
| | - Yanjing Wang
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongyun Zhang
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Beibei Chen
- Department of Gynecology, Hangzhou Women's Hospital, Hangzhou, China
| | - Dingheng Li
- Department of Gynecology, Hangzhou Women's Hospital, Hangzhou, China
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Cao S, Qiu G, Zhang P, Wang X, Wu Q. A Comparison of Transvaginal Removal and Repair of Uterine Defect for Type II Cesarean Scar Pregnancy and Uterine Artery Embolization Combined With Curettage. Front Med (Lausanne) 2021; 8:654956. [PMID: 34239887 PMCID: PMC8258109 DOI: 10.3389/fmed.2021.654956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/04/2021] [Indexed: 11/21/2022] Open
Abstract
Background: There is no consensus on a standardized therapy for type II cesarean scar pregnancy (CSP II). The objective of the present study was to evaluate the efficacy and safety and compare costs associated with transvaginal removal and repair (TRR) of uterine defect for CSP II to those of uterine artery embolization (UAE) and curettage. Methods: We conducted a retrospective study that included 87 patients diagnosed with CSP II and treated by performing UAE in combination with curettage and hysteroscopy (n = 53), or TRR (n = 34). Clinical data and outcomes were analyzed. Results: UAE and TRR groups exhibited similar success rates. The TRR group had significantly lower complication rates (30.19 vs. 8.82%, P < 0.05) and lower total costs (13,765.89 ± 2,029.12 vs. 9,063.82 ± 954.67, P < 0.05) than the UAE group. The anterior myometrium of the lower uterine segment was relatively thicker after performing TRR, and no patient suffered from recurrent CSP II. The proportion of patients in the TRR group who had full-term delivery without uterine rupture was 88.24% (30/34), while four patients failed to pregnancy. Conclusion: TRR is a safe and effective treatment method for patients with CSP II and presents a highly cost-effective outcome, especially for patients with future fertility desire.
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Affiliation(s)
- Shanshan Cao
- Tiantai People's Hospital of Zhejiang Province, Taizhou, China
| | - Guijing Qiu
- Tiantai People's Hospital of Zhejiang Province, Taizhou, China
| | - Peipei Zhang
- Tiantai People's Hospital of Zhejiang Province, Taizhou, China
| | - Xinyan Wang
- Department of Gynecology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Qing Wu
- Department of Gynecology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
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11
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Wu Q, Liu X, Zhu L, Zhu Y, Mei T, Cao S, Shen Y, Ding J, Lin T. Clinical Assessment of Ultrasound-Guided Local Lauromacrogol Injection Combined With Curettage and Hysteroscopy for Cesarean Scar Pregnancy. Front Pharmacol 2020; 11:601977. [PMID: 33408631 PMCID: PMC7779759 DOI: 10.3389/fphar.2020.601977] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/24/2020] [Indexed: 12/17/2022] Open
Abstract
Background: To evaluate the efficacy, safeness and cost of ultrasound-guided local lauromacrogol injection (USG-LLI) combined with curettage and hysteroscopy for cesarean scar pregnancy (CSP). Methods: This was a retrospective study included 151 CSP patients diagnosed with CSP from June 2017 to December 2019, and treated by USG-LLI (n = 86) or uterine artery embolization (UAE) (n = 65) combined with curettage and hysteroscopy. Clinical data and outcome were analyzed. Results: There were no significant differences in basic clinical characteristics in the two groups. Two groups showed the similar success rates. USG-LLI group, compared with UAE group had significantly lower complication rates (9.30 vs. 44.62%), lower total costs (both medical and non-medication cost) (p < 0.05). Conclusions: USG-LLI combined with curettage and hysteroscopy is a feasible method to treat CSP with minimal invasion and high efficacy. Moreover, compared with curettage after UAE, USG-LLI exhibited lower complication rate and required fewer expenses.
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Affiliation(s)
- Qing Wu
- Department of Gynecology, Zhejiang Provincial Peoples' Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Xia Liu
- Department of Obstetrics and Gynecology, Fujian Provincial Hospital, Clinical Medical School of Fujian Medical University, Fuzhou, China
| | - Lin Zhu
- Department of Obstetrics and Gynecology, Fujian Provincial Hospital, Clinical Medical School of Fujian Medical University, Fuzhou, China
| | - Yichen Zhu
- Zhejiang University School of Medicine, Hangzhou, China
| | - Tingting Mei
- Department of Gynecology, Zhejiang Provincial Peoples' Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Shanshan Cao
- Tiantai People's Hospital of Zhejiang Province, Zhejiang, China
| | - Yan Shen
- Department of Gynecology, Zhejiang Provincial Peoples' Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Jun Ding
- Department of Gynecology, Zhejiang Provincial Peoples' Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Tan Lin
- Department of Obstetrics and Gynecology, Fujian Provincial Hospital, Clinical Medical School of Fujian Medical University, Fuzhou, China
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Wei SS, Li DH, Zhang ZF, Sun WC, Jia CL. Type II caesarean scar pregnancy management by ultrasound-guided local lauromacrogol injection in combination with suction curettage: A case report. Medicine (Baltimore) 2020; 99:e19743. [PMID: 32332613 PMCID: PMC7220564 DOI: 10.1097/md.0000000000019743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 01/10/2020] [Accepted: 03/04/2020] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION The implantation of a gestational sac within the scar of a previous caesarean delivery is defined as caesarean scar pregnancy (CSP), which is classified into two types: CSP I and CSP II. CSP II is life threatening, and no clear consensus for CSP II management exists. PATIENT CONCERNS A 31-year-old woman, gravida 1, para 1, with a previous caesarean delivery due to macrosomia, presented with an estimated 45 days of amenorrhea. The patient presented to the emergency department with vaginal bleeding for 1 day and no abdominal pain. DIAGNOSES An ultrasound examination was performed demonstrating a viable fetus that was embedded in the caesarean scar area and was bulging through the wall of the uterus into the bladder without contact with the uterine cavity or cervical canal. A diagnosis of type II caesarean scar pregnancy was made. INTERVENTIONS Local lauromacrogol was used to reduce the gestational sac blood supply. Suction curettage was performed under the guidance of abdominal ultrasound 24 h later, and the amount of bleeding was 20 mL. The response to the treatment was monitored by serial beta-human chorionic gonadotropin (β-hCG). OUTCOMES Patient was followed up with β-hCG weekly levels which became <10 mIU/mL after 4 weeks of treatment. CONCLUSION Ultrasound-guided local lauromacrogol injection combined with suction curettage may be a safer and novel therapeutic method.
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Affiliation(s)
- Shuang-shuang Wei
- Department of Gynecology, Hangzhou Women's Hospital, Hangzhou, China
| | - Ding-heng Li
- Department of Gynecology, Hangzhou Women's Hospital, Hangzhou, China
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Qi F, Chai ZY, Liu MM, Zheng LZ, Zhu Y, Chen ZW, Lv WG. Type 2 Cesarean Scar Pregnancy Successfully Treated via Hysteroscopy-Assisted Laparoscopy. J Minim Invasive Gynecol 2019; 26:1273-1281. [DOI: 10.1016/j.jmig.2018.11.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 11/08/2018] [Accepted: 11/12/2018] [Indexed: 02/08/2023]
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