Risk factors for intra-operative haemorrhage and bleeding risk scoring system for caesarean scar pregnancy: a case–control study

Wang, Q.; Ma, Huanxin; Peng, Hongling; He, Lin; Bian, Ce; Zhao, Xia

doi:10.1016/j.ejogrb.2015.06.023

Cited by 34 publications

(50 citation statements)

References 10 publications

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“…ROC analysis further found that the best cutoff of menolipsis time was 51 days, also consistent with that of 8 weeks in the above study. In addition, the best cutoff of maximum diameter was 27 mm, less than that in the above studies, [7,8] which may be related to grouping criteria for bleeding. It should be noted that the above study did not use ROC analysis to obtain the critical value.…”

Section: Discussionmentioning

confidence: 69%

“…Thus, in this study, bleeding ≥200 mL was used as the critical cutoff for hemorrhage, in consistence with that of the study in 2015. [8] …”

Section: Discussionmentioning

confidence: 99%

“…In the 2015 study, [8] the meaningful factors for intraoperative hemorrhage include serum β-hCG >20,000 mIU/mL, gestational age >8 weeks, maximum diameter ≥5 cm, myometrial thickness ≤0.15 cm, and significant peritrophoblastic perfusion.…”

Section: Discussionmentioning

confidence: 99%

“…[12] Patients with bleeding ≥200 mL were grouped in the bleeding group (15 cases), and patients with blood loss < 200 mL were in the control group (43 cases). [8] …”

Section: Methodsmentioning

confidence: 99%

“…[7,8] Besides suction evacuation combined with preventive uterine artery embolization (UAE) treatments mentioned above, the current commonly used treatments for CSP include multiple treatments such as medication, UAE, curettage and surgery, and their combinations. However, every treatment option has risks of excessive hemorrhage from uterus.…”

Section: Introductionmentioning

confidence: 99%

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Analysis of risk factors for intraoperative hemorrhage of cesarean scar pregnancy

Shao

2017

Medicine

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The current commonly used treatments for cesarean scar pregnancy (CSP) include multiple treatments such as medication, uterine artery embolization, curettage and surgery, and their combinations. However, every treatment option has risks of excessive hemorrhage from uterus. In this study, we retrospectively analyzed the risk factors for intraoperative hemorrhage of different treatments for CSP patients, with the hope to provide the guidance for CSP treatment.Fifty-eight cases of CSP patients who were treated with curettage after medication, curettage after uterine artery embolization, or surgery were retrospectively analyzed and compared for the clinical efficacy, length of hospital stay, and hemorrhage rate. Further, they were divided into the bleeding group (≥200 mL, 15 cases) and the control group (<200 mL, 43 cases). The hemorrhage-related risk factors were subjected to univariate analysis, including age, pregnant times, delivery times, abortion times or curettage times, the time from last cesarean section, menolipsis time, serum human chorionic gonadotropin level, ultrasound typing, maximum diameter of gestational sac or mass under ultrasound, peritrophoblastic blood flow around the mass, and the distance of gestational sac or mass from the uterine serosa layer. The significant indexes in univariate analysis were further analyzed using both receiver operating characteristic (ROC) analysis and multivariate logistic regression analysis.The success rate, length of hospital stay, and hemorrhage rate were not significantly different among the 3 treatment groups (P > .05). Univariate analysis found that patients in the bleeding group had significantly longer menolipsis time and greater maximum diameter than patients in the control group (P < .05). ROC analysis showed that the optimal cutoff for menolipsis time and maximum diameter were 51 days and 27 mm, respectively, and the areas under their corresponding ROC were 0.680 and 0.787, respectively. Multivariate analysis showed that only the maximum diameter in the retrospective equation was of significance (P < .05, odds ratio: 1.067, 95% confidence interval: 1.014∼1.123].All treatments have high success rates and no significant effects on intraoperative bleeding. Both menolipsis time and maximum diameter can be used to predict the risk of intraoperative bleeding, and the latter have a greater predictive value.

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Section: Discussionmentioning

confidence: 69%

“…Thus, in this study, bleeding ≥200 mL was used as the critical cutoff for hemorrhage, in consistence with that of the study in 2015. [8] …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…[12] Patients with bleeding ≥200 mL were grouped in the bleeding group (15 cases), and patients with blood loss < 200 mL were in the control group (43 cases). [8] …”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Analysis of risk factors for intraoperative hemorrhage of cesarean scar pregnancy

Shao

2017

Medicine

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Scoring system for the prediction of the successful treatment modality in women with cesarean scar pregnancy

Sun

Luo

Gao

et al. 2019

Intl J Gynecology & Obste

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Objective: To establish a risk scoring system to predict the successful treatment of cesarean scar pregnancy. Methods:A prospective observational study was conducted between June 2016 and March 2018 in a tertiary care center. Patients received evacuation followed by uterine artery embolization and laparoscopic local resection/hysterectomy successively as salvage measures if necessary. Optimal scaling regression determined the extent of each potential prognostic factor predicted. Results: Out of 228 women, 144 cases required evacuation before recovery, 73 women required uterine artery embolization, and 11 women eventually required laparoscopic surgery. Six variables were included in the predictive model: number of cesarean deliveries; maximal diameter of gestational sac; remnant myometrial thickness; grading of Doppler signals; presence of fetal heartbeat; and location of gestational sac. A 10-point scoring system was established by weighting their prediction of the method of successful treatment. In the risk score rank of 1-4, only 4 (2.8%) out of 142 women needed uterine artery embolization as a salvage treatment, while in the risk score rank of 8-10, 41 (80.4%) cases needed uterine artery embolization; laparoscopic operations were performed by physicians for the other 10 (19.6%) cases. Conclusion:The successful treatment of cesarean scar pregnancy was accurately predicted by a 10-point scoring system. Chinese Clinical Trials Registry:ChiCTR-OOC-16008467.

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

Zhao

2021

Intl J Gynecology & Obste

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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.

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Risk factors for intra-operative haemorrhage and bleeding risk scoring system for caesarean scar pregnancy: a case–control study

Cited by 34 publications

References 10 publications

Analysis of risk factors for intraoperative hemorrhage of cesarean scar pregnancy

Analysis of risk factors for intraoperative hemorrhage of cesarean scar pregnancy

Scoring system for the prediction of the successful treatment modality in women with cesarean scar pregnancy

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

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