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Archives of Gynecology and Obstetrics

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01-02-2021 | Review

Risk factors for massive hemorrhage during the treatment of cesarean scar pregnancy: a systematic review and meta-analysis

Authors: Yuan Zhang, Zhongyun Zhang, Xiaoyan Liu, Lei Zhang, Fanzhen Hong, Ming Lu

Published in: Archives of Gynecology and Obstetrics | Issue 2/2021

Abstract

Purpose

Cesarean scar pregnancy (CSP) is one of the serious complications associated with cesarean delivery (CD). This meta-analysis aims to identify risk factors associated with massive hemorrhage during the CSP treatment.

Methods

Eight electronic databases were searched for case–control studies published before December 31th, 2018, which compared the possible factors causing massive bleeding during the CSP treatment. Quantitative synthesis was performed by RevMan 5.3. Sensitivity analysis and publication bias were performed by Stata 12.0.

Results

Total 20 case − control studies including 3101 CSP patients with previous CD met the inclusion criteria. Bleeding group had 573 patients and the control group had 2528 patients. The risk factors for massive bleeding during CSP treatment included multiple gravidities (MD = 0.15, 95% CI 0.03–0.28, P = 0.73), big maximum diameter of gestation sac (MD = 18.49 mm, 95%CI 15.34–21.65, P < 0.01), high gestational days (MD = 8.98 days, 95% CI 4.12–13.84, P < 0.01), high β-HCG level (MD = 21.39 IU/ml, 95% CI 7.36–35.41, P = 0.03; MD = 3.02 U/ml, 95% CI 0.21–5.84, P < 0.01) and rich blood flow around the lesion (OR = 6.73, 95% CI 3.93–11.51, P = 0.59). While, thick myometrium (MD = − 4.94 mm, 95% CI − 6.12 to − 3.75, P < 0.01) may be protective factor.

Conclusions

Multiple gravidities, big gestation sac, large gestational days, high serum β-HCG level, abundant blood supply to pregnancy sac and thin myometrium maybe the risk factors for massive bleeding during the CSP treatment.

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Title: Risk factors for massive hemorrhage during the treatment of cesarean scar pregnancy: a systematic review and meta-analysis
Authors: Yuan Zhang
Zhongyun Zhang
Xiaoyan Liu
Lei Zhang
Fanzhen Hong
Ming Lu
Publication date: 01-02-2021
Publisher: Springer Berlin Heidelberg
Published in: Archives of Gynecology and Obstetrics / Issue 2/2021
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-020-05877-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk factors for massive hemorrhage during the treatment of cesarean scar pregnancy: a systematic review and meta-analysis

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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