Exploring the value of cesarean section diverticulum area to predict the safety of hysteroscopic management for cesarean scar pregnancy patients

Abstract

Objective To study indicators predicting the safety of hysteroscopic management for cesarean scar pregnancy (CSP) patients. Methods This was a retrospective study, starting from June 1, 2020. The study included 141 CSP patients who underwent hysteroscopic surgery and met the requirements of gestational age ≤12 weeks, stable vital signs, and preoperative magnetic resonance imaging. Patients were divided into control group and testing group according to surgical outcomes. Preoperative indicators were compared between the two groups, including a novel indicator, cesarean section diverticulum (CSD) area. Results Univariate analysis identified five statistically significant (P < 0.05) factors associated with hysteroscopy failure including a large CSD area. Multifactor logistic regression analysis showed that the only statistically significant indicator of all five factors was the CSD area. The area under the receiver operating characteristics curve of CSD area was 0.848. Next, we determined three cut‐off values for CSD area that can be used to predict the outcome of surgery: 138, 189, and 300 mm2. Conclusion For the first time, we found that CSD area could predict the safety of hysteroscopic management for CSP patients and might be helpful for clinical decision making. The findings need to be verified by further research.

Clinical Application of a New Cesarean Scar Pregnancy Classification and Evaluation System and a Risk Scoring System

“…However, importantly, all the patients included in this study exhibited high risk factors, such as a mass protruding into the abdominal cavity or a discontinuous muscle layer. 25 Given these circumstances, it is worth considering whether hysteroscopic surgery truly benefits patients of this nature, as niche resection may be a more suitable alternative.…”