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Transvaginal hysterotomy for cesarean scar pregnancy in 40 consecutive cases.

ABSTRACT: To propose a novel procedure as a safe and effective treatment for cesarean scar pregnancy (CSP), a cohort study was initiated in patients diagnosed with CSP and treated with transvaginal hysterotomy from December 2009 to March 2013, either as a primary or secondary therapy. All diagnoses were confirmed by both sonography and pathology, either a gestational sac or residual tissue after termination of pregnancy or miscarriage in the cesarean section scar. Basic clinical characteristics and perioperative data were collected and analyzed. A total of 40 patients were included. The mean age was 32.88 ± 4.55 years. The mean size of gestational sacs of the CSP mass at diagnosis was 33.78 ± 13.14 mm. Mean serum β-hCG level at diagnosis was 47379.73 ± 45285.10 IU/L. Mean operative time was 57.25 ± 24.52 min. Mean postoperative hemoglobin drop was 1.635 ± 0.906 g/dL. Complications were one case of bacteremia and two cases of hematoma. Mean hospital stay after surgery was 4.95 ± 2.62 days. Mean serum β-hCG levels decreased by 88.5, 93.5, and 96.5 % at postoperative day 2, 4, and 6, respectively. All patients' β-hCG levels returned to normal range within 1 month after surgery. Transvaginal hysterotomy with removal of ectopic pregnancy tissue and repair of cesarean scar defect is a promising approach to manage CSPs, with a short hospital stay, low postoperative pain, blood loss, and cost.

SUBMITTER: Huanxiao Z

PROVIDER: S-EPMC4349961 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Cesarean scar defect often causes postmenstrual abnormal uterine bleeding, dysmenorrhea, chronic pelvic pain, and infertility, which are collectively known as cesarean scar syndrome (CSS). Several studies have reported that hysteroscopic surgery can restore fertility in women with CSS. The study aimed to identify factors that influence subsequent pregnancy following hysteroscopic surgery. Therefore, we studied 38 women with secondary infertility due to CSS who underwent hysteroscopic surgery at Shiga University of Medical Hospital between July 2014 and July 2019. Our hysteroscopic procedure included inferior edge resection and superficial cauterization of the cesarean scar defect under laparoscopic guidance. Patients were followed up for 3 to 40 months after surgery. Surgery was successful in all cases and no complications were observed. Twenty-seven patients (71%) became pregnant (pregnant group), while 11 (29%) did not (non-pregnant group). Baseline characteristics of age, body mass index, gravidity, parity, previous cesarean section, presence of endometriosis, retroflex uterus, and preoperative residual myometrial thickness were not significantly different between the groups. However, the median residual myometrium thickness was significantly higher after surgery than before surgery in the pregnant group (1.9 [1.1-3.6] vs 4.9 [3.4-6.6] mm, P<0.0001), whereas this difference was not significant in the non-pregnant group. Of those who became pregnant, 85% conceived within 2 years of surgery. Although three pregnancies resulted in abortion and one is ongoing at the time of writing, 23 pregnancies resulted in healthy babies at 35-38 gestational weeks by scheduled cesarean sections with no obstetrical complications due to hysteroscopic surgery. The average birth weight was 3,076 g. Our findings support that hysteroscopic surgery is a safe and effective treatment for secondary infertility due to CSS. The thickness of the residual myometrium may be a key factor that influences subsequent pregnancy in women with CSS.

Project description:Objectives: To evaluate the efficacy and health economics of four treatments for type 1 cesarean scar pregnancy (CSP). Methods: From January 2009 to December 2018, 326 patients diagnosed with type 1 CSP were examined, among whom 31 received ultrasound-guided local injection of methotrexate (local injection group), 160 patients received uterine artery embolization combined with suction aspiration (UAE group), 25 patients received ultrasound-guided suction aspiration (aspiration group) and 90 received ultrasound-guided local injection of lauromacrogol combined with suction aspiration (lauromacrogol group). Clinical data and outcomes were analyzed. The decision tree model was used to compare the economics of four treatments. Results: The success rate of the local injection group was 71.0% (22/31), which was significantly different from 98.8% (158/160) of the UAE group and 100.0% (90/90) of the lauromacrogol group. The success rate of the aspiration group was 92.0% (23/25), which was significantly lower than that of the lauromacrogol group. The cost-effectiveness ratio was 1,876.53 yuan for the aspiration group, 2,164.63 yuan for the lauromacrogol group, 4,383.56 yuan for the local injection group, and 7,850.81 yuan for the UAE group. The Incremental cost effectiveness ratio (ICER) of the lauromacrogol group to the aspiration group was 5,477.75 yuan, indicating that if the willing to pay of patients was higher than 5,477.75 yuan, the lauromacrogol group had a cost-effectiveness advantage in treating type 1 CSP, compared to aspiration group. On the contrary, aspiration group has a higher cost-effectiveness advantage. The ICER of the lauromacrogol group to the local injection group or the UAE group were both less than 0, indicating that local injection group and UAE group was not cost-effective in the treatment of type 1 CSP. Conclusion: For type 1 CSP, the ultrasound-guided local injection of lauromacrogol combined with suction aspiration and ultrasound-guided suction aspiration, are effective and economical, and the choice between the two can be based on the patient's willing to pay.

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Transvaginal hysterotomy for cesarean scar pregnancy in 40 consecutive cases.

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