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Year : 2020  |  Volume : 4  |  Issue : 2  |  Page : 89-96

Comparison of the efficacy and safety of different surgical strategies for patients with type II cesarean scar pregnancy

Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China

Correspondence Address:
Xiao-Fang Yi
Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, No. 419 Fangxie Road, Shanghai 200011
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2096-2924.288024

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Objective: To compare the efficacy and safety of four surgical strategies currently used for the management of deep implantation cesarean scar pregnancy (CSP-II). Methods: This was a retrospective clinical cohort study, and, in total, 131 women diagnosed with CSP-II and primarily treated in our hospital were recruited. Women treated using laparoscopy assisted by operative hysteroscopy (LAOH; Group A, n = 25), uterine artery embolization (UAE) followed by LAOH (Group B, n = 21), ultrasound-guided dilatation and curettage (D&C; Group C, n = 24), and UAE followed by D&C (Group D, n = 61) were evaluated. Univariate and multiple logistic analyses were performed to identify the risk factors. Results: No statistically significant difference was found in patient age, gestational age, size of lesion, and pretreatment serum β-human chorionic gonadotropins (β-hCG) level. Operation time was longer (P < 0.001) and the success rate was higher (P = 0.01) in both Group A and Group B than in Group C and Group D. When the cohort was further analyzed regarding patients with myometrial thickness ≤3 mm (n = 75, defined as CSP-IIb), a lower rate of perioperative complications (P = 0.036) and a higher success rate (P < 0.001) remained in Group A (n = 15) and Group B (n = 15) but not in Group C (n = 11) or Group D (n = 34). In multiple logistic regression analysis, the risk factors related to lower treatment efficacy for patients with CSP-II were thinner myometrial thickness of cesarean scar (CS) (≤3 mm) (odds ratio [OR] = 5.470, P = 0.062), number of cesarean sections (a2) (OR = 8.877, P = 0.013), mass protruding into the bladder or abdominal cavity (OR = 25.507, P < 0.001), and direct D&C modality (OR = 38.247, P = 0.010). Conclusions: Compared with D&C ± UAE, LAOH ± UAE showed a higher success rate for patients with CSP-II, especially when the zygote was more deeply implanted with a myometrial thickness of CS ≤ 3 mm. CSP-II treatment should be individualized on the basis of many risk factors.

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