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Archives of Gynecology and Obstetrics

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01-11-2015 | General Gynecology

Curettage or operative hysteroscopy in the treatment of cesarean scar pregnancy

Authors: Zhi-Da Qian, Li-Li Huang, Xiao-Ming Zhu

Published in: Archives of Gynecology and Obstetrics | Issue 5/2015

Abstract

Objectives

To compare the clinical effects of dilatation and curettage (D&C) regimen and operative hysteroscopy coupled with curettage regimen in the treatment of cesarean scar pregnancy (CSP) following preventive uterine artery embolization (UAE).

Materials and methods

Thirty-three women were treated with D&C after UAE (group A) and 33 women were treated with operative hysteroscopy coupled with curettage after UAE (group B). The clinical outcomes of the two groups were compared.

Results

There was no significant difference between the two groups with respect to the success rate, the intraoperative blood loss, the hysterectomy rate, the hospitalization time, the decline of serum β-hCG after surgery, the time of serum β-hCG resolution, the time of vaginal bleeding after surgery, the time to CSP mass disappearance, and the subsequent intrauterine pregnancies. The hospitalization cost in group B was higher than group A.

Conclusions

Both D&C and operative hysteroscopy coupled with curettage were successful in terminating a CSP. Hysteroscopy coupled with curettage regimen did not have significant advantages and good prognosis in dealing with the gestational sac type of CSP following preventive UAE compared with D&C regimen. Treatment should be individualized and several conditions must be considered.

Godin PA, Bassil S, Donnez J (1997) An ectopic pregnancy developing in a previous cesarean section scar. Fertil Steril 67:398–400CrossRefPubMed

Ash A, Smith A, Maxwell D (2007) Caesarean scar pregnancy. BJOG 114:253–263CrossRefPubMed

Qian ZD, Guo QY, Huang LL (2014) Identifying risk factors for recurrent cesarean scar pregnancy: a case-control study. Fertil Steril 102(129–134):e1

Wang JH, Qian ZD, Zhuang YL, Du YJ, Zhu LH, Huang LL (2013) Risk factors for intraoperative hemorrhage at evacuation of a cesarean scar pregnancy following uterine artery embolization. Int J Gynaecol Obstet 123:240–243CrossRefPubMed

Marcus S, Cheng E, Goff B (1999) Extrauterine pregnancy resulting from early uterine rupture. Obstet Gynecol 94:804–805CrossRefPubMed

Zhuang YL, Huang LL (2009) Uterine artery embolization compared with methotrexate for the management of pregnancy implanted within a cesarean scar. Am J Obstet Gynecol 201:152.e1–152.e3CrossRef

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 285:1313–1318CrossRefPubMed

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 89:163–166CrossRefPubMed

Huang L, Du Y, Zhao C (2014) High-intensity focused ultrasound combined with dilatation and curettage for cesarean scar pregnancy. Ultrasound Obstet Gynecol 43:98–101CrossRefPubMed

10.

Tekin YB, Ural UM, Balık G, Ustuner I, Şahin FK, Güven ESG (2014) Management of cesarean scar pregnancy with suction curettage: a report of four cases and review of the literature. Arch Gynecol Obstet 289:1171–1175CrossRef

11.

Wang CJ, Yuen LT, Chao AS, Lee CL, Yen CF, Soong YK (2005) Caesarean scar pregnancy successfully treated by operative hysteroscopy and suction curettage. BJOG 112:839–840CrossRefPubMed

12.

Wang CJ, Chao AS, Yuen LT, Wang CW, Soong YK, Lee CL (2006) Endoscopic management of cesarean scar pregnancy. Fertil Steril 85(494):e1–e4PubMed

13.

Wang CJ, Tsai F, Chen C, Chao A (2010) Hysteroscopic management of heterotopic cesarean scar pregnancy. Fertil Steril 94(1529):e15–e18PubMed

14.

Deans R, Abbott J (2010) Hysteroscopic management of cesarean scar ectopic pregnancy. Fertil Steril 93:1735–1740CrossRefPubMed

15.

Chiang AJ, La V, Chou CP, Wang PH, Yu KJ (2011) Ectopic pregnancy in a cesarean section scar. Fertil Steril 95:2388–2389CrossRefPubMed

16.

Chou YM, Wu D, Wu KY, Lee CL (2013) Hysteroscopic removal of cesarean scar pregnancy after methotrexate treatment failure. Gynecol Minim Invasive Ther 2:70–72CrossRef

17.

Kim K, Pietrzak A, Gonzalez S, Podgony K (2010) Severe hemorrhage in a first-trimester cesarean scar pregnancy during dilation and curettage. Int J Obstet Anesth 19:348–349CrossRefPubMed

18.

Sadeghi H, Rutherford T, Rackow BW, Campbell KH, Duzyj CM, Guess MK, Kodaman PH, Norwitz ER (2010) Cesarean scar ectopic pregnancy: case series and review of the literature. Am J Perinatol 27:111–120CrossRefPubMed

19.

Zhang B, Jiang ZB, Huang MS, Guan SH, Zhu KS, Qian JS, Zhou B, Li MA, Shan H (2012) Uterine artery embolization combined with methotrexate in the treatment of cesarean scar pregnancy: results of a case series and review of the literature. J Vasc Interv Radiol 23:1582–1588CrossRefPubMed

20.

Tagore S, Teo SHW, Chua SYI, Ong CL, Kwek YCK (2010) A retrospective review of uterine scar pregnancies: single centre experience. Arch Gynecol Obstet 282:711–715CrossRefPubMed

21.

Fylstra DL (2002) Ectopic pregnancy within a cesarean scar: a review. Obstet Gynecol Surv 57:537–543CrossRefPubMed

22.

Jain S, Suneja A, Malik R, Agarwal R, Guleria K, Vaid N (2014) Cesarean scar pregnancy: a diagnostic dilemma and impending catastrophe. Arch Gynecol Obstet 289:221–222CrossRefPubMed

23.

Herman A, Weinraub Z, Avrech O, Maymon R, Ron-Ei R, Bukovsky Y (1995) Follow up and outcome of isthmic pregnancy located in a previous caesarean section scar. Br J Obstet Gynaecol 102:839–841CrossRefPubMed

24.

Seow KM, Wang PH, Huang LW, Hwang JL (2013) Transvaginal sono-guided aspiration of gestational sac concurrent with a local methotrexate injection for the treatment of unruptured cesarean scar pregnancy. Arch Gynecol Obstet 288:361–366CrossRefPubMed

25.

Rotas MA, Haberman S, Levgur M (2006) Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol 107:1373–1381CrossRefPubMed

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 207:14–29CrossRefPubMed

27.

Maymon R, Halperin R, Mendlovic S, Schneider D, Herman A (2004) Ectopic pregnancies in a caesarean scar: review of the medical approach to an iatrogenic complication. Hum Reprod Update 10:515–523CrossRefPubMed

28.

Robinson JK, Dayal MB, Gindoff P, Frankfurter D (2009) A novel surgical treatment for cesarean scar pregnancy: laparoscopically assisted operative hysteroscopy. Fertil Steril 92(1497):e13–e16PubMed

29.

Luo ZQ, Zhou P, Gao F, Li RZ (2008) Value of intravaginal ultrasound diagnosis of pregnancy into a previous cesarean section cicatrix. Chin J Ultrasound in Medicine 24:65–67 (in Chinese)

30.

Chao A, Wang TH, Wang CJ, Lee CL, Chao AS (2005) Hysteroscopic management of cesarean scar pregnancy after unsuccessful methotrexate treatment. J Minim Invas Gynecol 12:374–376CrossRef

Title: Curettage or operative hysteroscopy in the treatment of cesarean scar pregnancy
Authors: Zhi-Da Qian
Li-Li Huang
Xiao-Ming Zhu
Publication date: 01-11-2015
Publisher: Springer Berlin Heidelberg
Published in: Archives of Gynecology and Obstetrics / Issue 5/2015
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-015-3730-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Curettage or operative hysteroscopy in the treatment of cesarean scar pregnancy

Abstract

Objectives

Materials and methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objectives

Materials and methods

Results

Conclusions

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