Management of Caesarean Scar Pregnancies Using an Intrauterine or Abdominal Approach Based on the Myometrial Thickness between the Gestational Mass and the Bladder Wall

Aims: To investigate the potential risk factors for haemorrhage during suction curettage after uterine artery embolization (UAE) in the treatment of caesarean scar pregnancy (CSP). Methods: A case-control study was executed including 35 patients with CSP and haemorrhage during suction curettage after UAE and 140 controls without haemorrhage. The data collected included gestational age, the distance between the gestational mass and the bladder, and the volume of vaginal bleeding. Results: Six patients with UAE needed blood transfusions and two had a hysterectomy, while no patient in the control group needed these interventions. Multivariate analysis showed that both gestational age and the distance between the gestational mass and the bladder were associated with haemorrhage in the CSP group. The odds ratio (OR) of gestational age between cases and controls was 1.579 (95% confidence interval [CI] 1.291-1.933), and the OR of the distance between the gestational mass and the bladder was 0.208 (95% CI 0.082-0.531). Conclusion: Increased gestational age might be an important risk factor for haemorrhage during suction curettage after UAE in the treatment of patients with CSP, and a distance of >0.2 cm between the gestational mass and the bladder was protective against haemorrhage.

Section: Discussionmentioning

confidence: 99%

Risk Factors for Haemorrhage during Suction Curettage after Uterine Artery Embolization for Treating Caesarean Scar Pregnancy: A Case-Control Study

Zhang

Wang³

2015

“…Given recent developments in operative hysteroscopy [11,12] and its advantages over more invasive techniques, including improved safety and a shorter recovery period, it has grown in popularity and is now commonly used. However, because of the special equipment required, operative hysteroscopy cannot always be carried out, particularly in underdeveloped or medically underserved areas.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Vaginal Surgery and Operative Hysteroscopy for the Treatment of Cesarean-Induced Isthmocele: A Retrospective Review

Xie

Fan

et al. 2014

Background/Aims: Cesarean-induced isthmocele can cause heavy or prolonged menses, dyspareunia, and dysmenorrhea. We compared the efficacy of vaginal surgery and operative hysteroscopy for the treatment of cesarean-induced isthmocele. Methods: Seventy-seven women with cesarean-induced isthmocele underwent either vaginal surgery or operative hysteroscopy between August 2008 and December 2011. We evaluated operating time, blood loss, complications, and postoperative pregnancy. Operative efficacy was defined as an improvement in menstrual periods and a change in residual isthmocele nidus size on transvaginal ultrasonography. Results: The operative efficacy of vaginal surgery was superior to that of hysteroscopy (93.5 vs. 64.5%; p < 0.001). However, patients who underwent vaginal surgery had a longer operative time (55 vs. 25 min; p < 0.001) and greater blood loss (50 vs. 10 ml; p < 0.001). Two patients in each group were able to achieve subsequent pregnancy. Patients who had menstrual periods longer than 7 days after surgery were more likely to have a residual nidus. Conclusions: The therapeutic efficacy of vaginal surgery is superior to operative hysteroscopy in the treatment of cesarean-induced isthmocele.

“…Since then, it has been used for the control of intractable uterine bleeding as well as for a variety of gynecologic conditions, such as uterine fibroids [9] or cesarean scar pregnancy [10,11,12]. …”

Section: Discussionmentioning

confidence: 99%

Postpartum Uterine Bleeding from the Inferior Mesenteric Artery: Case Report and Review of the Literature

Shin¹,

Yi²,

Chung

2015

Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide. The common causes of primary PPH include uterine atony, abnormal placentation, retained placenta, and birth canal injury. The inferior mesenteric artery (IMA) arises from the aorta and is the main artery to supply the descending and sigmoid colon, as well as the rectum. We present a case of immediate, severe uterine bleeding after a normal vaginal delivery; angiography determined that hemorrhage originated from the IMA, and there were no anastomoses between the IMA and other pelvic arteries. The patient was successfully managed by selective embolization of a distal branch of the IMA. Our case report presents a new and interesting variation of pelvic vascular anatomy; moreover, it is the first report to present a case of postpartum uterine bleeding originating from the IMA.