Abstract
Purpose
To explore the efficacy of treatment for early cesarean scar pregnancy (CSP) and to evaluate the characteristics of women with subsequent mixed mass formation.
Methods
Women with CSP, who received UACE followed by evacuation, were retrospectively analyzed. Clinical/sonographic characteristics in patients with or without mixed mass formation were compared.
Results
From a total of 395 cases, 105 cases had a pregnancy residual with mixed mass formation. Blood loss and subsequent salvage intervention were significantly lower in patients without mixed mass, although all women retained their uteri. It required 50 days for the mass to resolve, 40 days for β-hCG concentrations to drop back to normal, and 61 days for menses to be restored; all of which were significantly longer than the same indices in women without a mixed mass. Clinical/sonographic characteristics predicting residual mass formation were maximal diameter of gestational sac (OR = 1.05, P = 0.001, with a sensitivity and specificity of 68.6 and 80.3%, respectively), presence of a fetal heart beat (OR = 2.63, P = 0.002, with a sensitivity and specificity of 62.9 and 67.2%, respectively), remnant myometrial thickness (OR = 108.91, P = 0.001 when thickness was less than 1 mm, with a sensitivity and specificity of 42.9% and 96.6%), location of gestational sac (OR = 59.20, P = 0.01 for complete type, with a sensitivity and specificity of 99.0 and 36.9%), and Doppler signal grading (OR = 8.08, P = 0.013 for Grade III, with a sensitivity and specificity of 83.8 and 51.0%).
Conclusions
UACE followed by evacuation was effective for CSP and subsequent mixed mass formation could be predicted by some clinical/sonographic characteristics.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Rotas MA, Haberman S, Levgur M (2006) Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol 107(6):1373–1381. https://doi.org/10.1097/01.AOG.0000218690.24494.ce
Litwicka K, Greco E (2011) Caesarean scar pregnancy: a review of management options. Curr Opin Obstet Gynecol 23(6):415–421. https://doi.org/10.1097/GCO.0b013e32834cef0c
Osborn DA, Williams TR, Craig BM (2012) Cesarean scar pregnancy: sonographic and magnetic resonance imaging findings, complications, and treatment. J Ultrasound Med 31(9):1449–1456
Seow KM, Huang LW, Lin YH, Lin MY, Tsai YL, Hwang JL (2004) Cesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol 23(3):247–253. https://doi.org/10.1002/uog.974
Shen L, Tan A, Zhu H, Guo C, Liu D, Huang W (2012) Bilateral uterine artery chemoembolization with methotrexate for cesarean scar pregnancy. Am J Obstet Gynecol 207(5):e381–e386. https://doi.org/10.1016/j.ajog.2012.09.012
Qi F, Zhou W, Wang MF, Chai ZY, Zheng LZ (2015) Uterine artery embolization with and without local methotrexate infusion for the treatment of cesarean scar pregnancy. Taiwan J Obstet Gynecol 54(4):376–380. https://doi.org/10.1016/j.tjog.2015.01.003
Li Y, Wang W, Yang T, Wei X, Yang X (2016) Incorporating uterine artery embolization in the treatment of cesarean scar pregnancy following diagnostic ultrasonography. Int J Gynaecol Obstet 134(2):202–207. https://doi.org/10.1016/j.ijgo.2015.12.006
Yin X, Su S, Dong B, Ban Y, Li C, Sun B (2012) Angiographic uterine artery chemoembolization followed by vacuum aspiration: an efficient and safe treatment for managing complicated cesarean scar pregnancy. Arch Gynecol Obstet 285(5):1313–1318. https://doi.org/10.1007/s00404-011-2132-2
Cheng LY, Wang CB, Chu LC, Tseng CW, Kung FT (2014) Outcomes of primary surgical evacuation during the first trimester in different types of implantation in women with cesarean scar pregnancy. Fertil Steril 102(4):1085–1090. https://doi.org/10.1016/j.fertnstert.2014.07.003
Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson CJ (2003) First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment Cesarean section scar. Ultrasound Obstet Gynecol 21(3):220–227. https://doi.org/10.1002/uog.56
Pascual MA, Hereter L, Graupera B, Tresserra F, Fernandez-Cid M, Simon M (2007) Three-dimensional power Doppler ultrasound diagnosis and conservative treatment of ectopic pregnancy in a cesarean section scar. Fertil Steril 88(3):706. https://doi.org/10.1016/j.fertnstert.2006.11.183
Adler DD, Carson PL, Rubin JM, Quinn-Reid D (1990) Doppler ultrasound color flow imaging in the study of breast cancer: preliminary findings. Ultrasound Med Biol 16(6):553–559
Birch Petersen K, Hoffmann E, Rifbjerg Larsen C, Svarre Nielsen H (2016) Cesarean scar pregnancy: a systematic review of treatment studies. Fertil Steril 105(4):958–967. https://doi.org/10.1016/j.fertnstert.2015.12.130
Jurkovic D, Ben-Nagi J, Ofilli-Yebovi D, Sawyer E, Helmy S, Yazbek J (2007) Efficacy of Shirodkar cervical suture in securing hemostasis following surgical evacuation of Cesarean scar ectopic pregnancy. Ultrasound Obstet Gynecol 30(1):95–100. https://doi.org/10.1002/uog.4058
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(1):14–29. https://doi.org/10.1016/j.ajog.2012.03.007
Arslan M, Pata O, Dilek TU, Aktas A, Aban M, Dilek S (2005) Treatment of viable cesarean scar ectopic pregnancy with suction curettage. Int J Gynaecol Obstet 89(2):163–166. https://doi.org/10.1016/j.ijgo.2004.12.038
Yang XY, Yu H, Li KM, Chu YX, Zheng A (2010) Uterine artery embolisation combined with local methotrexate for treatment of caesarean scar pregnancy. BJOG 117(8):990–996. https://doi.org/10.1111/j.1471-0528.2010.02578.x
Gao L, Huang Z, Gao J, Mai H, Zhang Y, Wang X (2014) Uterine artery embolization followed by dilation and curettage within 24 hours compared with systemic methotrexate for cesarean scar pregnancy. Int J Gynaecol Obstet 127(2):147–151. https://doi.org/10.1016/j.ijgo.2014.05.005
Vial Y, Petignat P, Hohlfeld P (2000) Pregnancy in a cesarean scar. Ultrasound Obstet Gynecol 16(6):592–593. https://doi.org/10.1046/j.1469-0705.2000.00300-2.x
Wang Q, Ma H, Peng H, He L, Bian C, Zhao X (2015) Risk factors for intra-operative haemorrhage and bleeding risk scoring system for caesarean scar pregnancy: a case-control study. Eur J Obstet Gynecol Reprod Biol 195:141–145. https://doi.org/10.1016/j.ejogrb.2015.06.023
Acknowledgements
We thank for the ultrasonography team, who provided detailed and accurate sonographic information about the CSP cases.
Funding
This research was funded by grants from the National Natural Science Foundation of China (No. 81270758).
Author information
Authors and Affiliations
Contributions
Z-QC: project development and manuscript editing. Q-LS: manuscript editing. LL: data analysis. D-MY: data collection. XHW: data collection and manuscript writing YY: project development.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethics Committee of the Army Medical University, and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Sun, QL., Wu, XH., Luo, L. et al. Characteristics of women with mixed mass formation after evacuation following uterine artery chemoembolization for cesarean scar pregnancy. Arch Gynecol Obstet 297, 1059–1066 (2018). https://doi.org/10.1007/s00404-018-4716-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-018-4716-6