nach oben

Archives of Gynecology and Obstetrics

Erschienen in:

03.01.2021 | General Gynecology

Surgical outcomes of cesarean scar pregnancy: an 8-year experience at a single institution

verfasst von: Xiaofeng Xu, Dongdong Li, Lan Yang, Xiujuan Jing, Xiangyi Kong, Dezhu Chen, Tong Ru, Huaijun Zhou

Erschienen in: Archives of Gynecology and Obstetrics | Ausgabe 5/2021

Einloggen, um Zugang zu erhalten

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.

Larsen JV, Solomon MH (1978) Pregnancy in a uterine scar sacculus-an unusual cause of postabortal haemorrhage. A case report. S Afr Med J 53:142–143PubMed

Vial Y, Petignat P, Hohlfeld P (2000) Pregnancy in a cesarean scar. Ultrasound Obstet Gynecol 16:592–593. https://doi.org/10.1046/j.1469-0705.2000.00300-2.xCrossRefPubMed

Ash A, Smith A, Maxwell D (2007) Caesarean scar pregnancy. BJOG An Int J Obstet Gynaecol 114:253–263. https://doi.org/10.1111/j.1471-0528.2006.01237.xCrossRef

Zhang H, Huang J, Wu X et al (2017) Clinical classification and treatment of cesarean scar pregnancy. J Obstet Gynaecol Res 43:653–661. https://doi.org/10.1111/jog.13267CrossRefPubMed

Grechukhina O, Deshmukh U, Fan L et al (2018) Cesarean scar pregnancy, incidence, and recurrence. Obstet Gynecol 132:1285–1295. https://doi.org/10.1097/AOG.0000000000002940CrossRefPubMed

Orhan A, Kasapoğlu I, Çetinkaya Demir B et al (2019) Different treatment modalities and outcomes in cesarean scar pregnancy: a retrospective analysis of 31 cases in a unıversity hospital. Ginekol Pol 90:291–307. https://doi.org/10.5603/GP.2019.0053CrossRefPubMed

Seow K-M, Huang L-W, Lin Y-H et al (2004) Cesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol 23:247–253. https://doi.org/10.1002/uog.974CrossRefPubMed

Rotas MA, Haberman S, Levgur M (2006) Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol 107:1373–1381. https://doi.org/10.1097/01.AOG.0000218690.24494.ceCrossRefPubMed

Wang L, Xu X, Baker P et al (2016) Patterns and associated factors of caesarean delivery intention among expectant mothers in China: implications from the implementation of China’s new national two-child policy. Int J Environ Res Public Health 13:686. https://doi.org/10.3390/ijerph13070686CrossRefPubMedCentral

10.

Liu G, Wu J, Cao J et al (2017) Comparison of three treatment strategies for cesarean scar pregnancy. Arch Gynecol Obstet 296:383–389. https://doi.org/10.1007/s00404-017-4426-5CrossRefPubMed

11.

Lu Y-M, Guo Y-R, Zhou M-Y, Wang Y (2020) Indwelling intrauterine foley balloon catheter for intraoperative and postoperative bleeding in cesarean scar pregnancy. J Minim Invasive Gynecol 27:94–99. https://doi.org/10.1016/j.jmig.2019.02.024CrossRefPubMed

12.

Cali G, Forlani F, Timor-Tritsch IE et al (2017) Natural history of cesarean scar pregnancy on prenatal ultrasound: the crossover sign. Ultrasound Obstet Gynecol 50:100–104. https://doi.org/10.1002/uog.16216CrossRefPubMed

13.

Calì G, Forlani F, Minneci G et al (2018) First-trimester prediction of surgical outcome in abnormally invasive placenta using the cross-over sign. Ultrasound Obstet Gynecol 51:184–188. https://doi.org/10.1002/uog.17440CrossRefPubMed

14.

Ananth CV, Smulian JC, Vintzileos AM (1997) The association of placenta previa with history of cesarean delivery and abortion: a metaanalysis. Am J Obstet Gynecol 177:1071–1078. https://doi.org/10.1016/S0002-9378(97)70017-6CrossRefPubMed

15.

Kaelin Agten A, Cali G, Monteagudo A et al (2017) The clinical outcome of cesarean scar pregnancies implanted “on the scar” versus “in the niche.” Am J Obstet Gynecol 216:510.e1-510.e6. https://doi.org/10.1016/j.ajog.2017.01.019CrossRef

16.

Ben Nagi J, Ofili-Yebovi D, Marsh M, Jurkovic D (2005) First-trimester cesarean scar pregnancy evolving into placenta previa/accreta at term. J Ultrasound Med 24:1569–1573. https://doi.org/10.7863/jum.2005.24.11.1569CrossRefPubMed

17.

Timor-Tritsch IE, Monteagudo A, Cali G et al (2014) Cesarean scar pregnancy is a precursor of morbidly adherent placenta. Ultrasound Obstet Gynecol 44:346–353. https://doi.org/10.1002/uog.13426CrossRefPubMed

18.

Michaels AY, Washburn EE, Pocius KD et al (2015) Outcome of cesarean scar pregnancies diagnosed sonographically in the first trimester. J Ultrasound Med 34:595–599. https://doi.org/10.7863/ultra.34.4.595CrossRefPubMed

19.

Timor-Tritsch IE, Monteagudo A, Santos R et al (2012) The diagnosis, treatment, and follow-up of cesarean scar pregnancy. Am J Obstet Gynecol 207:44.e1-44.e13. https://doi.org/10.1016/j.ajog.2012.04.018CrossRef

20.

Birch Petersen K, Hoffmann E, Rifbjerg Larsen C, Nielsen HS (2016) Cesarean scar pregnancy: a systematic review of treatment studies. Fertil Steril 105:958–967. https://doi.org/10.1016/j.fertnstert.2015.12.130CrossRefPubMed

21.

Feng Y, Chen S, Li C et al (2016) Curettage after uterine artery embolization combined with methotrexate treatment for caesarean scar pregnancy. Exp Ther Med 12:1469–1475. https://doi.org/10.3892/etm.2016.3489CrossRefPubMedPubMedCentral

22.

Liu S, Sun J, Cai B et al (2016) Management of cesarean scar pregnancy using ultrasound-guided dilation and curettage. J Minim Invasive Gynecol 23:707–711. https://doi.org/10.1016/j.jmig.2016.01.012CrossRefPubMed

23.

Özcan HÇ, Uğur MG, Balat Ö et al (2018) Is ultrasound-guided suction curettage a reliable option for treatment of cesarean scar pregnancy? A cross-sectional retrospective study. J Matern Neonatal Med 31:2953–2958. https://doi.org/10.1080/14767058.2017.1359827CrossRef

24.

Le A, Li M, Xu Y et al (2019) Different surgical approaches to 313 cesarean scar pregnancies. J Minim Invasive Gynecol 26:148–152. https://doi.org/10.1016/j.jmig.2018.03.035CrossRefPubMed

25.

Cao SS, Zhu LH, Jin L et al (2014) Uterine artery embolization in cesarean scar pregnancy: safe and effective intervention. Chin Med J (Engl) 127:2322–2326. https://doi.org/10.3760/cma.j.issn.0366-6999.20140196CrossRef

26.

Timor-Tritsch IE, Monteagudo A (2012) Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy. A review. Am J Obstet Gynecol 207:14–29. https://doi.org/10.1016/j.ajog.2012.03.007CrossRefPubMed

27.

Maymon R, Svirsky R, Smorgick N et al (2011) Fertility performance and obstetric outcomes among women with previous cesarean scar pregnancy. J Ultrasound Med 30:1179–1184. https://doi.org/10.7863/jum.2011.30.9.1179CrossRefPubMed

28.

Wang Q, Peng H-L, He L, Zhao X (2015) Reproductive outcomes after previous cesarean scar pregnancy: follow up of 189 women. Taiwan J Obstet Gynecol 54:551–553. https://doi.org/10.1016/j.tjog.2015.08.006CrossRefPubMed

Titel: Surgical outcomes of cesarean scar pregnancy: an 8-year experience at a single institution
verfasst von: Xiaofeng Xu
Dongdong Li
Lan Yang
Xiujuan Jing
Xiangyi Kong
Dezhu Chen
Tong Ru
Huaijun Zhou
Publikationsdatum: 03.01.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Gynecology and Obstetrics / Ausgabe 5/2021
Print ISSN: 0932-0067
Elektronische ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-020-05906-7

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.

Newsletter bestellen

Springer Medizin

Surgical outcomes of cesarean scar pregnancy: an 8-year experience at a single institution