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Clinical and Experimental Obstetrics & Gynecology  2021, Vol. 48 Issue (2): 365-371    DOI: 10.31083/j.ceog.2021.02.2291
Original Research Previous articles | Next articles
Study on influencing factors and related clinical issues in cesarean scar pregnancy
Jun Xiong1, Fen Fu1, Wei Zhang1, Ji Luo1, Yuan-Yuan Xu1, Lu-Lu Le1, Xiao-Ju He1, *()
1Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
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Abstract  
Objective: This study aims to investigate the etiological and bleeding risk factors of cesarean scar pregnancy (CSP) and attempts to determine the clinical value of uterine artery embolization (UAE) combined with curettage, methotrexate (MTX) chemotherapy combined with curettage, and uterine curettage alone in terminating CSP. Materials and methods: A total of 154 patients with CSP and 155 patients with cicatricial uterus termination of pregnancy in the same period who were hospitalized in the Department of Obstetrics and Gynecology, Second Affiliated Hospital of Nanchang University from January 2013 to March 2020 were enrolled in this study. The clinical characteristics of the two groups were statistically analyzed, and CSP patients were divided into the UAE + uterine curettage group (n = 49), MTX + uterine curettage group (n = 33) and uterine curettage alone group (n = 72) according to different treatment methods. The scar thickness, intraoperative blood loss, time to resumption of menstruation and other indicators were compared and analyzed among the three groups. Results: The proportion of CSP patients with cesarean section time < 24 months and ≥ 60 months was significantly higher than that of pregnant women with scar uterus. In the MTX + curettage group, 2 cases had intraoperative blood loss of more than 200 mL where the gestational age was more than 10 weeks, in which they were given Foley's catheter balloon compression hemostasis. In patients with simple uterine curettage, 6 cases had intraoperative blood loss of more than 200 mL with a gestational age of more than 8 weeks. Two cases were given emergency interventional treatment, while four underwent Foley catheter balloon compression hemostasis. The recovery time of β-hCG in the UAE + curettage group was shortest, which was found to be statistically significant. Furthermore, menopause time, blood β-hCG level and gestational sac diameter were found to be positively correlated with the amount of bleeding, while the thickness of the uterine scar was negatively correlated with the amount of bleeding. Conclusions: Gestational age, blood β-hCG level before treatment, gestational sac diameter and scar thickness were early warning indicators to evaluate the amount of bleeding in the treatment of CSP. UAE OR MTX pretreatment before cesarean section in CSP patients can significantly reduce intraoperative blood loss, and MTX + curettage is safe and effective for patients with abundant blood flow around the gestational sac with a gestational age of 8–10 weeks. However, in regard to CSP patients with a gestational age greater than 10 weeks and rich blood flow around the gestational sac, UAE pretreatment followed by termination of pregnancy is preferred. In case of hemorrhage during uterine curettage, the emergency intrauterine balloon compression can achieves adequate hemostasis.
Key words:  Cesarean scar pregnancy (CSP)      Uterine artery embolization (UAE)      Methotrexate (MTX)      Uterine curettage     
Submitted:  12 September 2020      Revised:  21 October 2020      Accepted:  04 November 2020      Published:  15 April 2021     
Fund: 
20185244/Science and Technology Plan Fund of Jiangxi Provincial Health and Family Planning Commission
S2019ZRMSB1793/Construction project of 2018 Postgraduate Teaching Case Base of Nanchang University, the Jiangxi Province Natural Science Foundation of China
81760277/Chinese National Natural Science Foundation
*Corresponding Author(s):  Xiao-Ju He     E-mail:  hexiaoju21@163.com

Cite this article: 

Jun Xiong, Fen Fu, Wei Zhang, Ji Luo, Yuan-Yuan Xu, Lu-Lu Le, Xiao-Ju He. Study on influencing factors and related clinical issues in cesarean scar pregnancy. Clinical and Experimental Obstetrics & Gynecology, 2021, 48(2): 365-371.

URL: 

https://ceog.imrpress.com/EN/10.31083/j.ceog.2021.02.2291     OR     https://ceog.imrpress.com/EN/Y2021/V48/I2/365

[1] Ja Young Kim, Yun Gyu Song, Chang-Woon Kim, Moon Ok Lee. Uterine artery embolization using gelatin sponge particles for symptomatic focal and diffuse adenomyosis[J]. Clinical and Experimental Obstetrics & Gynecology, 2021, 48(1): 59-65.
[2] L.B. Liu, H.T. Sun, S.F. Liu, R.X. Shi. Laparoscopy combined with hysteroscopy for cesarean scar pregnancy[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(6): 911-914.
[3] L. Xie, Y. Wang, Y.C. Man, F.Y. Luo. Preliminary experience in uterine artery embolization for second trimester pregnancy induced labor with complete placenta previa, placenta implantation, and pernicious placenta previa[J]. Clinical and Experimental Obstetrics & Gynecology, 2017, 44(1): 81-84.
[1] Eli M. Roth, Michael H. Davidson. PCSK9 Inhibitors: Mechanism of Action, Efficacy, and Safety[J]. Reviews in Cardiovascular Medicine, 2018, 19(S1): 31 -46 .
[2] Sandeep K. Krishnan, Norman E. Lepor. Acute and Chronic Cardiovascular Effects of Hyperkalemia: New Insights Into Prevention and Clinical Management[J]. Reviews in Cardiovascular Medicine, 2016, 17(S1): 9 -21 .
[3] Ibrahim Sidiqi, Patrick Alexander. Current Advances in Endovascular Therapy for Infrapopliteal Artery Disease[J]. Reviews in Cardiovascular Medicine, 2015, 16(1): 36 -50 .
[4] Prakash C. Deedwania. Management of Patients With Stable Angina and Type 2 Diabetes[J]. Reviews in Cardiovascular Medicine, 2015, 16(2): 105 -113 .
[5] Peter Shalit. Management of Dyslipidemia in Patients With Human Immunodeficiency Virus[J]. Reviews in Cardiovascular Medicine, 2014, 15(S1): 38 -46 .
[6] Sophie Mavrogeni, Fabrizio Cantini, Gerald M. Pohost. Systemic Vasculitis: An Underestimated Cause of Heart Failure—Assessment by Cardiovascular Magnetic Resonance[J]. Reviews in Cardiovascular Medicine, 2013, 14(1): 49 -55 .
[7] Prabhjot Singh Nijjar, Anoop Parameswaran, Aman M. Amanullah. Evaluation of Anomalous Aortic Origins of the Coronaries by 64-Slice Cardiac Computed Tomography[J]. Reviews in Cardiovascular Medicine, 2007, 8(3): 175 -181 .
[8] Jeffrey W. Moses, Stephane Carlier, Issam Moussa. Lesion Preparation Prior to Stenting[J]. Reviews in Cardiovascular Medicine, 2004, 5(S2): 16 -21 .
[9] Dean J. Kereiakes. Coronary Small-Vessel Stenting in the Era of Drug Elution[J]. Reviews in Cardiovascular Medicine, 2004, 5(S2): 34 -45 .
[10] M. Pakiž, L. Lukman, N. Kozar. Patients' and physicians' expectations differ significantly during the follow-up period after completion of primary treatment of gynecological or breast cancer[J]. European Journal of Gynaecological Oncology, 2019, 40(5): 781 -786 .