Conservative surgical treatment for caesarean scar pregnancy

Analysis of risk factors for intraoperative hemorrhage of cesarean scar pregnancy

The current commonly used treatments for cesarean scar pregnancy (CSP) include multiple treatments such as medication, uterine artery embolization, curettage and surgery, and their combinations. However, every treatment option has risks of excessive hemorrhage from uterus. In this study, we retrospectively analyzed the risk factors for intraoperative hemorrhage of different treatments for CSP patients, with the hope to provide the guidance for CSP treatment.Fifty-eight cases of CSP patients who were treated with curettage after medication, curettage after uterine artery embolization, or surgery were retrospectively analyzed and compared for the clinical efficacy, length of hospital stay, and hemorrhage rate. Further, they were divided into the bleeding group (≥200 mL, 15 cases) and the control group (<200 mL, 43 cases). The hemorrhage-related risk factors were subjected to univariate analysis, including age, pregnant times, delivery times, abortion times or curettage times, the time from last cesarean section, menolipsis time, serum human chorionic gonadotropin level, ultrasound typing, maximum diameter of gestational sac or mass under ultrasound, peritrophoblastic blood flow around the mass, and the distance of gestational sac or mass from the uterine serosa layer. The significant indexes in univariate analysis were further analyzed using both receiver operating characteristic (ROC) analysis and multivariate logistic regression analysis.The success rate, length of hospital stay, and hemorrhage rate were not significantly different among the 3 treatment groups (P > .05). Univariate analysis found that patients in the bleeding group had significantly longer menolipsis time and greater maximum diameter than patients in the control group (P < .05). ROC analysis showed that the optimal cutoff for menolipsis time and maximum diameter were 51 days and 27 mm, respectively, and the areas under their corresponding ROC were 0.680 and 0.787, respectively. Multivariate analysis showed that only the maximum diameter in the retrospective equation was of significance (P < .05, odds ratio: 1.067, 95% confidence interval: 1.014∼1.123].All treatments have high success rates and no significant effects on intraoperative bleeding. Both menolipsis time and maximum diameter can be used to predict the risk of intraoperative bleeding, and the latter have a greater predictive value.

Risk factors associated with failure of treatment for cesarean scar pregnancy

OBJECTIVE

To identify risk factors associated with treatment failure among women with cesarean scar pregnancy (CSP).

METHODS

In a retrospective study, the medical records of patients with CSP treated at National Taiwan University Hospital, Taipei, Taiwan, from 1994 to 2015 were reviewed. The women were managed primarily with hysterotomy, evacuation, or methotrexate. Receiver operating characteristic (ROC) curve analysis and logistic regression analysis were used to evaluate the factors associated with treatment failure.

RESULTS

Among 90 patients, 44 underwent hysterotomy, 18 underwent evacuation, and 28 received methotrexate. The success rates were 100% (44/44) for hysterotomy, 83% (15/18) for evacuation, and 57% (16/28) for methotrexate (P<0.001). ROC curve analysis indicated that a pregnancy length of 8 weeks and a mean sac diameter (MSD) of 4 cm were both predictive of failure of treatment by primary evacuation and methotrexate. In multivariate logistic regression analysis, an MSD of 4 cm or more was the only independent risk factor for treatment failure (odds ratio 68.99, 95% confidence interval 6.27-759.60; P=0.001).

CONCLUSION

Primary hysterotomy was suitable for treatment of CSP of any size. Failure of primary evacuation or methotrexate usually occurred when the MSD was larger than 4 cm.