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

Archives of Gynecology and Obstetrics volume 303, pages 1223–1233 (2021)Cite this article

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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References

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

    CAS  PubMed  Google Scholar 

  2. 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.x

    CAS  Article  PubMed  Google Scholar 

  3. 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.x

    CAS  Article  Google Scholar 

  4. 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.13267

    CAS  Article  PubMed  Google Scholar 

  5. 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.0000000000002940

    Article  PubMed  Google Scholar 

  6. 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.2019.0053

    Article  PubMed  Google Scholar 

  7. 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.974

    Article  PubMed  Google Scholar 

  8. 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.ce

    Article  PubMed  Google Scholar 

  9. 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/ijerph13070686

    Article  PubMed Central  Google Scholar 

  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/s00404-017-4426-5

    CAS  Article  PubMed  Google Scholar 

  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.2019.02.024

    Article  PubMed  Google Scholar 

  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.16216

    CAS  Article  PubMed  Google Scholar 

  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.17440

    Article  PubMed  Google Scholar 

  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)70017-6

    CAS  Article  PubMed  Google Scholar 

  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.2017.01.019

    Article  Google Scholar 

  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.2005.24.11.1569

    Article  PubMed  Google Scholar 

  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.13426

    CAS  Article  PubMed  Google Scholar 

  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.34.4.595

    Article  PubMed  Google Scholar 

  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.2012.04.018

    Article  Google Scholar 

  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.2015.12.130

    Article  PubMed  Google Scholar 

  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.2016.3489

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  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.2016.01.012

    Article  PubMed  Google Scholar 

  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/10.1080/14767058.2017.1359827

    Article  Google Scholar 

  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.2018.03.035

    Article  PubMed  Google Scholar 

  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.0366-6999.20140196

    Article  Google Scholar 

  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.2012.03.007

    Article  PubMed  Google Scholar 

  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.2011.30.9.1179

    Article  PubMed  Google Scholar 

  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.2015.08.006

    Article  PubMed  Google Scholar 

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Author information

Author notes

  1. Xiaofeng Xu and Dongdong Li contributed equally.

Affiliations

  1. 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

    Xiaofeng Xu, Dongdong Li, Lan Yang, Xiujuan Jing, Xiangyi Kong, Tong Ru & Huaijun Zhou

  2. Department of Nuclear Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, People’s Republic of China

    Dezhu Chen

Authors
  1. Xiaofeng Xu
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  2. Dongdong Li
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  3. Lan Yang
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  4. Xiujuan Jing
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  5. Xiangyi Kong
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  6. Dezhu Chen
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  7. Tong Ru
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  8. Huaijun Zhou
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Contributions

HZ: Protocol/project development. XK, DC: data collection or management, LY, XJ, TR: ultrasonic image review, XX, DL: data analysis, XX, DL: manuscript writing and editing, HZ: data and manuscript checking.

Corresponding author

Correspondence to Huaijun Zhou.

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The authors declare that they have no conflict of interests.

Ethics approval

This study was approved by the Ethics Committee of The Affiliated Drum Tower Hospital of Nanjing University Medical School.

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All participants in this study had informed consent.

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Xu, X., Li, D., Yang, L. et al. Surgical outcomes of cesarean scar pregnancy: an 8-year experience at a single institution. Arch Gynecol Obstet 303, 1223–1233 (2021). https://doi.org/10.1007/s00404-020-05906-7

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  • DOI: https://doi.org/10.1007/s00404-020-05906-7

Keywords

  • Ultrasonography
  • Curettage
  • Ectopic pregnancy
  • Surgery
  • Laparoscopy