Patients with type I and II cesarean scar pregnancy can be treated efficaciously and safely with curettage by pituitrin combined with ultrasonic monitoring and hysteroscopy-guided surgery, while patients with type III cesarean scar pregnancy would be safer treated with laparoscopic surgery, according to authors of a study published in BMC Women’s Health.
In cases of cesarean scar pregnancy (in which the embryo has implanted on or in a myometrial scar from a prior cesarean birth), tissues need to be removed before gestational week 12 to avoid potential iatrogenic consequences. Investigators in China sought to compare the clinical efficacy of various surgical methods in the treatment of 3 types of cesarean scar pregnancy.
Their study was conducted at the department of Obstetrics and Gynecology of the First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China between June 2017 and June 2020. The Family Planning Group, the Chinese Medical Society of Obstetrics, and Gynecology Expert Consensus on Diagnosis and Treatment of Cesarean Section Scar Pregnancy classified cesarean scar pregnancy into 3 types based on the thickness of the myometrium between the implanted pregnancy sac and the bladder wall, blood flow features, the direction of growth of the pregnancy sac, ultrasound findings of gestational sac implantation into the myometrial defect along the anterior wall caused by a prior cesarean delivery.
The current study included 314 patients with cesarean scar pregnancy managed by various surgeries and assessed based on the treatment methods used. The patients in group A (n=146) underwent curettage by pituitrin combined with ultrasonic monitoring and hysteroscopy-guided surgery, while patients in group B (n=90) underwent curettage after injection of methotrexate into the local gestational sac. Patients in group C (n=78) were treated with laparoscopic, transvaginal, and transabdominal cesarean scar resection. Each of the 3 groups was subdivided into cesarean scar pregnancy types I, II, and II based on results of ultrasonography. In group A, 64 patients had type I cesarean scar pregnancy, 77 had type II, and 5 had type III. In group B, 42 patients had type I cesarean scar pregnancy, 48 had type II, and 0 had type III. In group C, 26 patients had type I cesarean scar pregnancy, 37 had type II, and 15 had type III.
The authors found that, overall, patients in group A had shorter times to serum β-HCG normalization and menstrual recovery, less intraoperative blood loss, shorter length of postoperative hospital stay, and lower hospitalization costs than patients in groups B or C (P <.05). They noted that, compared with groups B and C with type I and type II cesarean scar pregnancy, patients in group A had higher rates of successful second pregnancy and operative efficiency (with group C type II rates higher than those of group B type II).
Among patients with type III cesarean scar pregnancy, those in group A had more serious complications than group C; 3 of the 5 group A patients experienced intraoperative hemorrhage and were transferred to laparotomy or laparoscopic surgery. The patients in groups A and B had significantly shorter operative time than those in group C with types I and II.
There were no between-group (group A type III and group C type III) differences in intraoperative blood loss or operative time or operative efficiency. Hospital length of stay and hospitalization costs were significantly lower in group A type III compared with those in group C type III. Menstrual recovery time and β-HCG recovery time were lower in group A type III than those in group C type III, but without statistical significance.
Study limitations include underpowered sample size (particularly in group A type III and group B type III) and the lack of control groups or randomization.
“Curettage by pituitrin combined with ultrasonic monitoring and hysteroscopy-guided surgery is an effective and relatively safe treatment for patients with type I and II [cesarean scar pregnancy],” researchers concluded, adding, “Laparoscopic surgery is more suitable for [patients with] type III [cesarean scar pregnancy].”
This article originally appeared on Dermatology Advisor
Zeng S, Wang Y, Ye P, et al. Comparing the clinical efficacy of 3 surgical methods for cesarean scar pregnancy. BMC Women’s Health. Published online May 17, 2023. doi:10.1186/s12905-023-02415-y