Efficacy of transcatheter uterine artery embolization in scar pregnancy patients of different ages based on random walk model / 中国医师杂志

Objective:To explore the efficacy and safety of cesarean scar pregnancy (CSP) in different ages treated by uterine artery embolization (UAE).Methods:120 patients with CSP admitted to Jiangyin Hospital of Traditional Chinese Medicine from July 2016 to July 2019 were selected as the research objects. They were divided into observation group (≤35 years, 75 cases) and control group (>35 years, 45 cases) according to age. Clinical data of all patients were collected and followed up for 6 months. The clinical observation indicators, surgical efficacy, Visual Analogue Scale (VAS) score, ovarian recovery, postoperative complications and adverse reactions, and quality of life score at 6 months after surgery were compared between the two groups. A random walk model was used to evaluate the improvement of ovarian function in the two groups.Results:In the observation group, the blood loss, operation time, postoperative β-human chorionic gonadotropin (β-HCG) value, β-HCG value turning negative and menstrual recovery time were significantly less than those in the control group (all P<0.05). The total effective rate was above 90% in the two groups, and no significant difference was observed (96.00% vs 91.11%, P>0.05). There was no statistical significance in VAS score of the two groups before surgery, 48 h and 72 h after surgery (all P>0.05), and VAS score of the observation group at 12 h and 24 h after surgery were significantly higher than those of the control group (all P<0.05). The levels of serum follicle stimulating hormone (FSH), estradiol (E 2), testosterone (T) and luteinizing hormone (LH) in observation group were better than those in control group after treatment (all P<0.05). There was no significant difference in the incidence of secondary uterine clearance, massive bleeding, hysterectomy, incision infection, vaginal bleeding and vaginal hematoma between the two groups (all P>0.05), but the total incidence of complications in observation group was significantly lower than that in control group ( P<0.05). Diarrhea, fever, nausea and vomiting, abdominal pain and other adverse reactions were significantly improved after symptomatic treatment, and there was no significant difference in the incidence of adverse reactions between the two groups ( P>0.05). There was no significant difference in the quality of life score 6 months after surgery between the two groups ( P>0.05). The results of random walk model evaluation showed that the improvement coefficients of the observation group were 0.147 6, 0.135 9, 0.180 2 and 0.206 3, while those of the control group were 0.142 2, 0.098 9, 0.152 4 and 0.197 4, respectively. Conclusions:UAE treatment for CSP patients of different ages showed no significant difference in clinical efficacy, and postoperative complications were not easy to occur, and the prognosis was good.

Clinical value of laparoscopic reversible uterine artery occlusion in treatment of cesarean section scar pregnancy / 中华内分泌外科杂志

Objective:To explore the clinical value of laparoscopic reversible uterine artery occlusion in the treatment of cesarean section scar pregnancy.Methods:A total of 112 patients who were hospitalized in our hospital from Sep. 2018 to Jun. 2020 in the First Affiliated Hospital of Bengbu Medical College and diagnosed with type II and type III cesarean section scars were selected. The patients were divided into groups according to the randomization method, the control group ( n=58) and the study group ( n=54) . The control group used uterine artery embolization combined with laparoscopic removal of pregnancy and uterine scar repair, while the study group used laparoscopic reversible uterine artery occlusion, pregnancy removal surgery and uterine scar repair surgery. The clinical treatment effects of the two groups of patients were compared. Results:The intraoperative blood loss of the control group (21.26±9.64) ml was significantly less than that of the study group (75.25±8.25) ml ( P<0.05) ; the treatment success rate of the study group was 98.15% (53/54) , which was significantly higher than the control group 86.21% (50/58) ( P<0.05) ; the time of vaginal bleeding in the study group (7.26±0.94) d, postoperative menstrual regain time (31.25±1.26) d, and hospital stay (3.14±0.25) d were significantly less than those in the control group ( (9.54±0.94) 0.86) d, (47.25±2.15) d, (9.26±0.94) d) ] ( P<0.05) ; 24 h β-hCG level and β-hCG negative time study group [ (1015.11±325.05) IU/L, (14.25±3.21) d] was significantly less than the control group [ (2654.25±284.25) IU/L, (27.16±5.14) d] ( P<0.05) ; there was no difference in the scores of the modified SF-36 scale before treatment between the two groups ( P>0.05) . The modified SF-36 scale score (63.22±4.25) of the study group after treatment was significantly higher than that of the control group (55.25±3.83) ( P<0.05) . Conclusions:Laparoscopic reversible uterine artery occlusion is effective in treating cesarean section scar pregnancy. After treatment, the β-hCG level of the patient is significantly reduced and the quality of life is significantly improved.

Transvaginal ultrasound and contrast-enhanced ultrasound combined with clinical factors to assess the treatment options of cesarean scar pregnancy / 中华超声影像学杂志

Objective:To investigate the significance of clinical factors combined with transvaginal ultrasound and contrast-enhanced ultrasound(CEUS) in guiding the choice of treatment plan for cesarean scar pregnancy(CSP).Methods:The clinical and transvaginal ultrasound and CEUS data of 120 patients with CSP from January 2016 to June 2021 in the First People′s Hospital of Foshan were retrospectively analyzed, and they were divided into ultrasound-guided curettage/ hysteroscopic group (Group A, 91 cases) and laparoscopic group (Group B, 29 cases) according to treatment option, and the differences in clinical and ultrasound factors between the two groups were compared, and to determine the relevant clinical and ultrasound indicators for the choice of treatment option.Results:There were statistical differences between the 2 groups in comparison of whether the gestational sac/mass protruded toward the plasma membrane, gestational sac/mass diameter, the main blood supply site of the gestational sac/mass, the site of the chorion/early placenta and scar thickness (all P<0.05). Logistic regression analysis indicated that CEUS showing major blood supply site of the gestational sac/mass ( OR=6.029, P=0.003) and uterine scar thickness ( OR=12.998, P=0.002) were independent risk factors for minimally invasive surgery for CSP. Conclusions:Ultrasound combined with clinical factors have a certain value in the selection of treatment options for CPS, and the thickness of the uterine scar and the main blood supply site of the gestational sac/mass showed in CEUS may be key factors affecting the minimally invasive surgical treatment of CSP.

A scary complication: single-center study on management and outcome of cesarean scar pregnancy

Abstract A cesarean scar pregnancy (CSP) is a scary and life-threatening complication of cesarean section (CS). Nevertheless, the incidence of CS is constantly growing. The CSP incidence is 0,15% of pregnancies after CS which represents 6,1% of all ectopic pregnancies in women with condition after CS. Therefore, it should be more present in the clinical daily routine. From mild nonspecific symptoms to hypovolemic shock, diagnosis and therapy must be performed quickly. With the progressive growth of the scar pregnancy, a uterine rupture involves the risk of severe bleeding, and an emergency hysterectomy could be necessary. Prolongation of pregnancy has been successful only in a few cases.We report 11 cases from our hospital in the past 10 years. In the discussion, treatment options of this complication with an increasing incidence, which is associated with serious morbidity and mortality, are presented based on the current literature. Treatment options include drug therapy, but also surgical or combined procedures with radiological intervention.

Tratamiento del embarazo ectópico en cicatriz de cesárea: revisión de la literatura a propósito de 3 casos / Treatment of ectopic pregnancy in a cesarean scar: review of the literature regarding 3 cases

INTRODUCCIÓN Y OBJETIVOS: El embarazo en cicatriz de cesárea previa (ECC) es una entidad poco frecuente que puede tener graves consecuencias. Hasta la fecha no existen esquemas estandarizados de tratamiento y su manejo óptimo sigue siendo controvertido. Nuestro objetivo es realizar una revisión de la literatura publicada sobre el manejo del ECC y proponer un algoritmo. También exponemos tres casos de ECC resueltos con diferentes tratamientos en el Hospital Universitario Infanta Elena MÉTODOS: Búsqueda de la literatura en bases de datos utilizando las palabras clave: "embarazo en cicatriz cesárea"," gestación ectópica en cicatriz cesárea", "tratamiento", "manejo". RESULTADOS: Las opciones terapéuticas pueden ser médicas, quirúrgicas o una combinación de ambas. Los tratamientos quirúrgicos tienen altas tasas de éxito, sin embargo, son más invasivos y no están exentos de riesgo. La combinación de tratamientos parece aumentar la tasa de éxito, no obstante, podría implicar un mayor riesgo de efectos secundarios y costes. CONCLUSIONES: El manejo de los ECC debe de ser individualizado, basado en la evidencia científica, en los medios disponibles y la experiencia de los profesionales en los distintos procedimientos, guiándonos por el tipo de ECC y su grado de vascularización e invasión, grosor del miometrio, niveles de beta-hCG, presencia de actividad cardiaca, clínica y estabilidad hemodinámica de la paciente. Deben tenerse en cuenta las circunstancias y patología intercurrente de la mujer, así como su deseo genésico o de preservación del útero.

INTRODUCTION AND OBJECTIVES: Cesarean scar pregnancy (CSP) is a rare entity that can cause serious consequences. Up to now, there are no standardized treatment schemes, and its optimal management remains controversial. Our objetive is to review the literature regarding CSP management and propose an algorithm. We also present three cases of CSP resolved with different treatments at Hospital Universitario Infanta Elena. METHODS: Literature search in databases using the following keywords: pregnancy with cesarean section, ectopic pregnancy with cesarean section, treatment, management. RESULTS: The therapeutic options can be medical, surgical or a combination of both. Surgical treatments have high success rates; however, they are more invasive and are not without risk. The combination of treatments seems to increase the success rate; however, it could imply a higher risk of side effects and costs. CONCLUSIONS: The management of CSP must be individualized; based on scientific evidence, on the means available, and on the experience of the professionals in the different procedures; guided by the type of CSP and its degree of vascularization and invasion, by the thickness of the myometrium, beta-hCG levels, presence of cardiac activity, and by clinical and hemodynamic stability of the patient. The circumstances and intercurrent pathology of the patient must be considered, as well as her desire for future pregnancy or preservation of the uterus.

The menace of caesarean scar pregnancy: a management challenge in modern obstetrics

Background: With the increasing caesarean section rates a new challenging evil of caesarean scar pregnancy (CSPs) has emerged. As a variant of ectopic pregnancy caesarean scar pregnancy is the rarest of all. Diagnosis and management of CSP can be challenging especially when there are no early symptoms and even lessor index of suspicion.  Objective of this endeavour was to present one institute experience of management of caesarean scar pregnancies.Methods: This are a retrospective analysis of women admitted with CSP. Detailed history, investigation, management protocols and complications were noted.Results: Of the total cases maximum women (60%) had history of previous two caesarean section. 90 % of cases were managed successfully with intra-sac or systemic methotrexate, and surgical evacuation with Foley’s catheter tamponade, only two women needed hysterectomy for uncontrolled bleeding.Conclusions: Caesarean scar pregnancy is a diagnostic and management challenge in modern obstetrics. Early ultrasound diagnosis helps in planning a successful medical treatment and serves to preserve uterus and fertility. Treatment with transabdominal intra-sac methotrexate and Foley’s catheter for tamponade is safe and effective method of treating CSPs.

Surgical management of caesarean scar pregnancy: a case report

Caesarean scar ectopic is one of the rarest of all ectopic pregnancies. The incidence of caesarean scar pregnancy (CSP), which was extremely rare till recent times, has been rising steadily. Case have more of such cases being published in medical literature now. It is defined as when a blastocyst implants on a previous caesarean scar. The incidence of caesarean scar ectopic has increased due to increase in number of caesarean deliveries. Early diagnosis of this can be done by using ultrasound. It is very important because a delay can lead to increased maternal morbidity and mortality. Early diagnosis leads to prompt management and improves the outcome by allowing preservation of future fertility. Magnetic resonance imaging (MRI) has important role when sonography is equivocal or inconclusive before therapy or intervention. Case are reporting a rare case of G2P1l1 with previous one caesarean delivery, diagnosed as caesarean scar ectopic pregnancy with the help of sonography. Patient underwent laparotomy and on histopathological examination caesarean scar pregnancy was confirmed. Due to the rarity of this condition, there are no specific guidelines available for its management.

Evaluation of prognostic value of cesarean section scar pregnancy after uterine arterial chemoembolization with cesarean section by ultrasonography / 中华超声影像学杂志

Objective@#To assess the clinical value of uterine curettage ultrasound in the evaluation of cesarean section scar pregnancy (CSP) after uterine arterial chemoembolization (UAE).@*Methods@#Retrospective analysis were performed in 42 patients who took uterine curettage within 24-48 hours after UAE treatment in the Second Affiliated Hospital of Harbin Medical University from January 2015 to June 2018. The ultrasonic manifestations were graded and classified before UAE. The intraoperative and postoperative complications, time of β-human chorionic gonadotrophin declined to normal limits were evaluated, and the formation of hematoma and hematoma absorption time were followed up by ultrasound.@*Results@#UAE was performed successfully in all patients. The ultrasound-guided scar pregnancy was successfully completed. The uterus was successfully retained in all patients.Among the 42 patients, 18 cases were 3 scores group, and 24 cases were 4 scores group according to the ultrasonic scoring system. Two cases were type Ⅰgroup, 25 cases were type Ⅱ group, and 15 cases were type Ⅲ group according to the ultrasonic classification. The amount of intraoperative complications, postoperative mass formation and absorption time were significantly different between 3 scores group and 4 scores group (P<0.05). No significant differences were found in intraoperative complications, postoperative complications, postoperative mass formation and β-human chorionic gonadotropin (β-hCG) value among different ultrasonic classification groups (P>0.05).@*Conclusions@#Ultrasonography has clinical application value in evaluating the prognosis of CSP treated with UAE. Ultrasonic scoring system can evaluate the efficacy and is helpful for predicting clinical outcome of CSP.

Diagnostic value of magnetic resonance imaging in cesarean scar pregnancy / 第二军医大学学报

Objective To analyze the magnetic resonance imaging (MRI) features of caesarean scar pregnancy (CSP), and to evaluate the diagnosis value of MRI in CSP. Methods The MRI data of 38 patients with clinically and pathologically confirmed CSP were retrospectively analyzed. These patients aged 19 to 50 years old, with one to two previous cesarean sections. The interval between this pregnancy and the last cesarean section was 2 to 11 years, the menopause time was 32 to 90 days, the urine human chorionic gonadotrophin (HCG) were all positive, and the blood β-HCG was 159.7-210 800.0 U/L. Twenty-nine cases were treated due to a small amount of vaginal bleeding after menopause, and nine cases due to abdominal pain. Results On the sagittal T2-weighted image, 38 cases of gestational sacs were clearly showed, of which 28 cases had round or oval morphology, with low signal on T1 and high signal on T2; 10 cases of gestational sacs showed irregular mixed cystic solidity with slightly low signal on T1 and slightly high signal on T2, and the contents were significantly strengthened after the enhancement. In all cases, the cyst wall was intact and located at the scar of the cesarean section of the anterior inferior wall of the uterus. In two cases of MRI grade 0, the gestational sac was located on the scar surface and grew into the uterine cavity without involving the myometrium; in 13 cases of grade 1, the gestational sac slightly invaded the myometrium, but mainly grew in the uterine cavity, with a clear boundary between the gestational sac and the myometrium; in 14 cases of grade 2, the gestational sac was small and completely implanted into the myometrium, the endometrial junction was continuously interrupted, the anterior-inferior wall of the uterus was thin, in the shape of “W” or “U”, without invading the serosa; in nine cases of grade 3, the gestational sac was large, completely implanted into the myometrium and protruded out of the uterine contour, compressing the bladder. Fifteen patients of MRI grade 0 and 1 were mainly treated with methotrexate, mifepristone or misoprostol, and/or ultrasound-guided curettage; 23 patients of grade 2 and 3 were mainly treated with curettage, excision of scar lesions and scar repair. Conclusion The typical MRI features of CSP can guide the clinical treatment decision-making, especially for the choice of operation mode.

Caesarean scar pregnancy: a case report with review of management options

Cesarean scar pregnancy is a rare but life-threatening complication. It is the abnormal implantation of gestational sac into myometrium and fibrous scar of previous cesarean section. Its incidence is on rising trend due to increase in rate of cesarean section all over the world. A thirty years old second gravida presented at eight weeks of gestation with complaints of bleeding per vaginum and pain lower abdomen. She was diagnosed as a case of cesarean scar pregnancy (CSP) on ultrasonography and confirmation of diagnosis was done on magnetic resonance imaging. Medical management of scar pregnancy was done successfully with combination of mifepristone and methotrexate. Cesarean scar pregnancy could be catastrophic, if not managed well in time. Management includes both surgical and medical options. Treatment has to be individualized depending on patient’s hemodynamic profile, size of gestational sac, desire for future fertility, compliance for follow up and availability of interventional radiology.

Cesarean scar pregnancy: scope for hysteroscopy

Scar ectopic pregnancy also known as cesarean scar pregnancy is a rare form of an extrauterine pregnancy. The blastocyst is implanted at the site of the previous cesarean scar. Most patients remain asymptomatic and are detected on routine ultrasonography imaging. The diagnosis and management of this condition is hence challenging and difficult. A timely ultrasonography in the early weeks of gestation is the key to preventing catastrophic events like uterine perforation and excessive hemorrhage. There is a wide armamentarium of treatment modalities to choose from, however each case must be individualised. Medical management has its own limitations and often patients are required to have a long-term follow-up. We present a case of a cesarean scar pregnancy managed conservatively with systemic methotrexate but subsequently requiring surgical intervention done successfully via hysteroscopy. A repeat ultrasonography done a fortnight later revealed no retained products of conception.

Management for abdominal pregnancy at Dhaka: A case report

Pregnancy in abdominal cavity is an unusual type of ectopic pregnancy having excessive illness as well as death for the mother and the unborn baby. Identification and management may present several complications, particularly in low-resource centers. A higher level of doubt is crucial in making a timely diagnosis in these cases. A 25-year-old third gravida patient was shifted to a tertiary care center in the city on the advice of failed induction. Her previous attempt of abortion procedure failed. It was observed from her ultrasonography that her right lower abdominal cavity contained single deformed fetus with no cardiac activity. After successful laparotomy, the mass was removed from in between uterus and urinary bladder. This situation shows that several pregnancies of abdomen could be supervised properly. A case is presented here where a pregnancy in abdomen was productively taken care of by operational laparotomy. The patient had a healthy recovery. This occurrence shows that operative laparotomy is a secure substitute for the supervision of appropriately designated patients in midtrimester pregnancy in abdomen.

Clinical value of uterine artery embolization in the treatment of caesarean scar pregnancy in the second trimester of pregnancy / 中国实用妇科与产科杂志

OBJECTIVE: To analyse the clinical value of uterine artery embolization(UAE)in the treatment of caesarean scar pregnancy(CSP)in the second trimester of pregnancy.METHODS: The clinical data of 29 cases treated from January2013 to June 2018 in Shengjing Hospital of China Medical University was retrospective analyzed.The patients were divided into group A(14 cases)and group B(15 cases)according to the first hospital. visitedPatients in group A first visited basic local hospitals and underwent drug-induced labor.Due to a large amount of vaginal bleeding or failure of induced labor,they were transferred to our hospital for further treatment. Patients in group B first visited our hospital and were treated by UAE before induced labor. The therapeutic effect was compared between the two groups.RESULTS: There was no statistical difference between the two groups in age,gestational weeks,number of caesarean section,period of time from previous caesarean section,or number of previous induced abortions(P>0.05).The average operation time of group B was shorter than that of group A[(54.00±31.19)min vs.(105.07±67.92)min,P<0.05]. The average intraoperative bleeding of group B was less than that of group A[(73.33±24.57)mL vs.(869.29±276.99)mL,P<0.05].Postoperative vaginal bleeding time of group B was shorter than that of group A[(4.46±1.06)d vs.(6.79±2.08)d,P<0.05].Average hospitalization time of group B was shorter than that of group A[(8.80±1.74)d vs.(14.57±4.54)d,P<0.05].The transfusion rate of group B was lower than that of group A[0 vs.78.6%,P<0.05].The uterine retention rate of group B was higher than group A[100% vs.71.4%,P<0.05].CONCLUSION: UAE has significant clinical value in the treatment of CSP in the second trimester of pregnancy.It can reduce operation time,intraoperative bleeding volume and increase uterine retention rate.

A comparative study of the consistency of ultrasound with MRI on the diagnosis of uterine cesarean scar pregnancy / 中国实用妇科与产科杂志

OBJECTIVE: To explore the consistency of ultrasound with MRI on the diagnosis of uterine cesarean scar pregnancy（CSP）.METHODS: Retrospectively analyze the clinical data of 91 patients from January 2012 to June 2018 in Beijing Chaoyang Hospital and Beijing Luhe Hospital.RESULTS: The ultrasonic:77 cases of CSP were clearly diagnosed（84.6%）,12 cases were suspicious for CSP（13.2%）and 2 cases were misdiagnosed（2.2%）.MRI showed that 90 cases of CSP were clearly diagnosed（98.9%）one case was misdiagnosed（1.1%）.Totally 32 cases were found to have yolk sac in ultrasonography,27 cases of them had fetal buds,and 20 cases of them had embryocardia-beats,while MRI could not distinguish the yolk sac from the fetal bud,and was unable to verify the embryocardia-beats.CONCLUSION: Ultrasonography can be used as the basis for screening and classification of CSP,which can help the early detection and the choice of treatment.The MRI images of CSP have certain specificity,which can provide more accurate imaging data for clinical diagnosis and treatment.3.The combination of ultrasound and MRI can significantly reduce the misdiagnosis of CSP.

Effect analysis of the cesarean scar pregnancy with intervention treatment and expectant treatment / 中国实用妇科与产科杂志

OBJECTIVE: To discuss the clinical significance of cesarean scar pregnancy with expectatant treatment.METHODS: Collect 21 cases of CSP between 2012 and 2017 in the Third Affiliated Hospital of Guangzhou Medical University.Group A had 8 cases who were pregnant again after intervention treatment,and group B had 13 cases who insisted on expecting treatment.We summarized clinical indexes of both groups,such as preserving uterus,bladder rupture,admission to ICU,blood transfusion,placenta implantation,etc. in order to further study the significance of expecting treatment for CSP.RESULTS: All of group A were pregnant again after intervention treatment,of whom 1 was CSP again and hysterectomy was performed at 15 weeks due to placenta implantation,while another 7 were uterine pregnancy,of whom 3 were term birth and had no placenta implantation,and another 4 were terminated in response to the requirements of patients,of whom 1 was treated with drug abortion and 3 underwent dilatation and curettage.Uterus was preserved in the 7 women,and there was no bladder rupture,no admission to ICU,no blood transfusion,and no placenta implantation.Among the 13 cases in group B, 6 cases underwent cesarean section during third trimester,including 3 cases of premature delivery and 3 cases of delivery at 37 weeks.5 cases were pregnant to second trimester,containing 4 cases received hysterectomy and 1 case suffered subtotal hysterectomy.2 cases were pregnant to first pregnancy, including 1 case of abdominal nidus resection, 1 case of ultrasound-guided dilation and curettage;Among the13 patients, 4 cases underwent bladder rupture, 4 cases lost uterus, 5 cases were admitted to the ICU, and 10 cases required blood transfusion.Placental implantation occurred in 11 cases who were pregnant to second and third trimester.CONCLUSION: Most of CSP with expecting treatment will develop into placenta implantation inevitably in the late stage of pregnancy.The patients with CSP can be pregnant again after early intervention and have extremely low possibility of a second CSP.

Treatment Efficacy Analysis in Patients with Type Ⅱ Cesarean Scar Pregnancy Treated with Different Minimally Invasive Surgical Methods / 中国医科大学学报

Objective To discuss the clinical effects of hysteroscopy and hysteroscopy combined with laparoscopy on typeⅡcesarean scar pregnancy (CSP). Methods We selected 58 patients diagnosed as having typeⅡCSP in Shengjing Hospital, China Medical University, between February 2013 and January 2016. Group A consisted of 36 patients who were treated with hysteroscopic CSP resection, while group B consisted of 22 patients treated with hysteroscopy combined with laparoscopic CSP resection and uterine repair. We compared the operation condition, single-operation success rate, postoperative recovery, and succeeding pregnancy outcome. Results The operation time in group A was 26.6±4.9 min, which was obviously shorter than that in group B. The bleeding volume in group A was 71.9±9.7 mL, which was obviously less than that in group B. No operation complication occurred in the two groups. The single-operation success rate was83.3％ in group A and 86.4％ in group B, indicating no significant difference. No significant differences in menstruation recovery and the rate of decrease in human chorionic gonadotropin level to normal were found between groups A and B. Conclusion Both hysteroscopy and hysteroscopy combined with laparoscopy can be used to treat typeⅡcesarean scar pregnancy.

Clinical efficacy of vaginal repair for type Ⅱ cesarean scar pregnancy / 局解手术学杂志

Objective To explore the clinical efficacy of vaginal hysterectomy and uterine scar repair in the treatment of type Ⅱ cesare-an scar pregnancy. Methods A total of 157 patients with type Ⅱ cesarean scar pregnancy (CSP) admitted to our obstetrics and gynecology department of our hospital from July 2016 to July 2017 were selected as research subjects. They were divided into ultrasound curettage group (n =87) and vaginal repair group(n =70) according to different surgical methods. The surgical bleeding volume, operative time, hospital stay and human chorionic gonadotropin (β-HCG) level before and after operation,the time of blood β-HCG returning to normal level,hemoglobin (HB) level before and after operation,menstrual recovery time,stress response, inflammatory response and surgical complications were compared between the two groups. Results The intraoperative blood loss volume, operative time and hospital slay in ultrasound curettage group were lower than those in vaginal repair group,the difference was significant(P ＜0.05). The time of blood β-HCG returning to normal level in vaginal repair group after operation was shorter than that in ultrasound curettage group, the difference was significant (P ＜ 0. 05). There was no significant difference in the HB level between the two groups(P＞0.05). The menstrual recovery time in vaginal repair group was shorter than that in ultrasound curettage group,the difference was significant(P ＜0. 05). The levels of postoperative epinephrine (E) and Cortisol (Cor) in vaginal repair group after operation were lower than those in ultrasound curettage group, while the level of thyroid stimulating hormone (TSH) was higher than that in ultrasound curettage group,the difference was significant(P ＜0.05). The levels of IL-2, IL-6 and IL-8 in vaginal repair group after operation were lower than those in ultrasound curettage group while the level of C-reactive protein (CRP) was higher than that in ultrasound curettage group,the difference was significant(P ＜0.05). The incidence rate of postoperative complications in ultrasound curettage group was higher than that in vaginal repair group(P ＜0. 05). Conclusion Vaginal repair is more beneficial to shortern the time of blood β-HCG returning to normal level and menstrual recovery time, promote the inflammatory factor and hormone recovery to a normal level, and reduce the incidence of complication.

Effect of combining uterine artery chemoembolization with curettage in treatment of caesarean scar pregnancy and influence factors / 实用放射学杂志

Objective To evaluate the effect of combination of uterine artery chemoembolization and curettage in treatment of caesarean scar pregnancy(CSP),and to analyze the possible influence factors.Methods 46 cases with caesarean scar pregnancy treated by the combination of uterine artery chemoembolization and curettage were retrospectively analyzed.Univariate analysis was made on the factors that might influence the efficacy,and the Logistic regression model was constructed for the significant variables.Results All of the patients were terminated pregnancy succesfully .According to the ultrasound recheck,there were no residual gestational sac tissue in 29 patients,and some residual gestational sac tissue in 17 patients.After the application of traditional Chinese medicine or methotrexate and other symptomatic treatment, the pregnancy was terminated.The univariate analysis showed that the number of cesarean section,the gestational sac volume,the gestational weeks,the type of CSP,and the condition of the fetal heart pulsation were related to the presence of residues in the uterus after treatment (P＜0.05).The multivariate analysis showed that gestational sac volume ＞9 cm3 ,gestational weeks ＞ 7 weeks and exogenous CSP were the independent factors leading to intrauterine residual gestational sac tissue.Conclusion Uterine artery chemoembolization combined with curettage is an effective method for treatment of caesarean scar pregnancy.It is proposed that clinical treatment should pay close attention to the factors that may affect the efficacy.

Pregnancy as a ticking bomb: A sonographic review of type II cesarean section scar pregnancy / Philippine Journal of Obstetrics and Gynecology

@#Cesarean section scar pregnancy (CSP) is a pregnancy implanted outside the uterine cavity in the site of a previous cesarean section scar and is considered the rarest form ectopic pregnancy. CSP is a modern phenomenon and has been reported with increasing incidence due to either an increased reporting or increasing cesarean section rate. The true incidence, however, has not been fully determined as some cases will end up in the first trimester and go unreported or undiagnosed. Undiagnosed cesarean scar pregnancy can be fatal due to life threatening hemorrhage as well as uterine rupture due to an abnormally adherent placenta. Accurate diagnosis is important because it enables the clinicians to establish the risk of complications and aid in prompt management. Ultrasonography is often the first step in detecting CSP and MRI should only be used in equivocal cases. The case presented is in a multiparous woman with ultrasound finding of a cesarean scar pregnancy where expectant management was the initial option but because of the outward progression of the CSP, it was terminated. There is no established universal treatment guidelines for CSP and treatment options include expectant, medical, surgical or combinations of these.

Ultrasound-guided local injection of methotrexate and systemic intramuscular methotrexate in the treatment of cesarean scar pregnancy

OBJECTIVE: To assess the efficacy and safety of ultrasound-guided intragestational injection of methotrexate (MTX) and systemic intramuscular MTX in the management of cesarean scar pregnancies. METHODS: This was a retrospective case-control study that included women diagnosed with cesarean scar pregnancy at CHA Bundang Medical Center unit between 2009 and 2015. The 26 cases were managed with local injection of MTX under ultrasound guidance and 15 cases were treated with systemic intramuscular of MTX. After the procedure, serial follow-up sonographic examination and serum beta-human chorionic gonadotropin (β-hCG) measurement were performed. RESULTS: The mean initial β-hCG level was 20,610.73 mIU/mL and ranged from 263.00–71,316.50 mIU/mL. Mean gestational age was 6.3 weeks and ranged from 4.8 to 8.5 weeks. The majority of ectopic cases were treated successfully and follow-up β-hCG level declined abruptly following the first dose of MTX. The rate of success of local MTX treatment was significantly higher than that of systemic MTX treatment. It was 93.75% vs. 73.33%, respectively (P < 0.05). CONCLUSION: Ultrasound-guided intragestational injection of MTX is an effective method for the management of cesarean scar pregnancies and is associated with minimal side effects and high treatment success.