Surgical evacuation of cesarean scar ectopic pregnancies

Nijjar, S; Jauniaux, Eric

doi:10.1016/j.bpobgyn.2023.102361

Cited by 5 publications

(4 citation statements)

References 58 publications

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“…Given the high risk of severe maternal morbidity, some experts prefer to apply intervention at a tertiary care hospital rather than expectant management. 4 , 11 Among the therapeutic modalities, the best method should be selected according to the patient medical condition, fetal viability, gestational age, the patient's desire for future pregnancy, and the available facilities, as well as the skill and experience of the surgeons. 2 …”

Section: Discussionmentioning

confidence: 99%

Paradoxical air embolism in patients undergoing hysteroscopic surgery for cesarean scar pregnancy: A case report and review of the literatures

Amirkhanloo,

Haddadi,

Ebrahimi

2024

Clinical Case Reports

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Section: Discussionmentioning

confidence: 99%

Paradoxical air embolism in patients undergoing hysteroscopic surgery for cesarean scar pregnancy: A case report and review of the literatures

Amirkhanloo,

Haddadi,

Ebrahimi

2024

Clinical Case Reports

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“…CSEPs are known to be associated with high maternal morbidity, particularly massive obstetric hemorrhage, uterine rupture, placenta accreta syndrome and emergency hysterectomy. 5 , 6 , 7 Termination of pregnancy is often offered to women in the early first trimester to prevent these complications. Treatment of early first trimester CSEPs is usually effective and safe, and primary surgical treatment modalities involve suction evacuation and sometimes with resection of the niche containing the pregnancy via laparoscopy and hysteroscopy.…”

Section: Introductionmentioning

confidence: 99%

“…Treatment of early first trimester CSEPs is usually effective and safe, and primary surgical treatment modalities involve suction evacuation and sometimes with resection of the niche containing the pregnancy via laparoscopy and hysteroscopy. 5 However the management of more advanced cases is challenging, because the associated risk of maternal morbidity increases beyond the first trimester, particularly 9–11 weeks' gestation. 6 , 7 As the pregnancy develops in the cesarean scar, the placenta is directly perfused by the radial or arcuate arteries.…”

Section: Introductionmentioning

confidence: 99%

Surgical evacuation combined with Shirodkar cervical suture and selective uterine artery embolization: A fertility preserving treatment for 10–15 weeks' live cesarean scar ectopic pregnancies

Nijjar,

Ngo,

de Braud

et al. 2024

Acta Obstet Gynecol Scand

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IntroductionCesarean scar ectopic pregnancies (CSEPs) are associated with significant maternal morbidity and termination is often recommended in the early first trimester. Management of more advanced cases is challenging due to higher risks of major intraoperative hemorrhage. Hysterectomy is currently the intervention of choice for advanced cases. This study aimed to investigate if advanced live CSEPs could be managed effectively conservatively using suction curettage and interventional radiology.Material and methodsA retrospective single‐center cohort study was performed. A total of 371 women diagnosed with CSEP were identified between January 2008 and January 2023. A total of 6% (22/371) women had an advanced live CSEP with crown‐rump length (CRL) of ≥40 mm (≥10 weeks' gestation). Of these, 77% (17/22) opted for surgical intervention, whilst the remaining five continued their pregnancies. A preoperative ultrasound was performed in each patient. All women underwent suction curettage under ultrasound guidance and insertion of Shirodkar cervical suture as a primary hemostatic measure combined with uterine artery embolization (UAE) if required. The primary outcome was rate of blood transfusion. Secondary outcomes were estimated intraoperative blood loss, UAE, intensive care unit admission, reintervention, hysterectomy, hospitalization duration and rate of retained products of conception. Descriptive statistics were used to describe these variables.ResultsMedian CRL of the 17 patients included was 54.1 mm (range: 40.0–85.7) and median gestational age based on CRL was 12 + 3 weeks (range: 10 + 6–15 + 0). On preoperative ultrasound scan placental lacunae were recorded in 76% (13/17) of patients and color Doppler score was ≥3 in 67% (10/15) of patients. At surgery, Shirodkar cervical suture was used in all cases. It was successful in achieving hemostasis by tamponade in 76% (13/17) of patients. In the remaining 24% (4/17) patients tamponade failed to achieve complete hemostasis and UAE was performed to stop persistent arterial bleeding into the uterine cavity. Median intraoperative blood loss was 800 mL (range: 250–2500) and 41% (7/17) women lost >1000 mL. 35% (6/17) needed blood transfusion. No women required hysterectomy.ConclusionsSurgical evacuation with Shirodkar cervical suture and selective UAE is an effective treatment for advanced live CSEPs.

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“…These associated risks can pose significant threats to the patient’s reproductive health and overall well-being. 1 , 2 Recent trends reveal a progressive increase in the incidence of CSP, attributable to changes in fertility policies, advancements in diagnostic technology, and the high rate of cesarean sections. 3 , 4 Statistical data indicates a CSP prevalence of 1.15% among women with a history of cesarean sections.…”

Section: Introductionmentioning

confidence: 99%

Analysis of Risk Factors for Intraoperative Bleeding in the Surgical Treatment of Cesarean Scar Pregnancy and Development of Predictive Models

Wan,

Wang,

Feng

et al. 2024

JMDH

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Objective The objective of this study was to investigate the risk factors associated with cesarean scar pregnancy (CSP) and to develop a model for predicting intraoperative bleeding risk. Methods We retrospectively analyzed the clinical data of 208 patients with CSP who were admitted to the People’s Hospital of Leshan between January 2018 and December 2022. Based on whether intraoperative bleeding was ≥ 200 mL, we categorized them into two groups for comparative analysis: the excessive bleeding group (n = 27) and the control group (n = 181). Identifying relevant factors, we constructed a prediction model and created a nomogram. Results We observed that there were significant differences between the two groups in several parameters. These included the time of menstrual cessation ( P = 0.002), maximum diameter of the gestational sac ( P < 0.001), thickness of the myometrium at the uterine scar ( P = 0.001), pre-treatment blood HCG levels ( P = 0.016), and the grade of blood flow signals ( P < 0.001). We consolidated the above data and constructed a clinical prediction model. The model exhibited favorable results in terms of predictive efficacy, discriminative ability (C-index = 0.894, specificity = 0.834, sensitivity = 0.852), calibration precision (mean absolute error = 0.018), and clinical decision-making utility, indicating its effectiveness. Conclusion The clinical prediction model related to the risk of hemorrhage that we developed in this experiment can assist in the development of appropriate interventions and effectively improve patient prognosis.

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Surgical evacuation of cesarean scar ectopic pregnancies

Cited by 5 publications

References 58 publications

Paradoxical air embolism in patients undergoing hysteroscopic surgery for cesarean scar pregnancy: A case report and review of the literatures

Paradoxical air embolism in patients undergoing hysteroscopic surgery for cesarean scar pregnancy: A case report and review of the literatures

Surgical evacuation combined with Shirodkar cervical suture and selective uterine artery embolization: A fertility preserving treatment for 10–15 weeks' live cesarean scar ectopic pregnancies

Analysis of Risk Factors for Intraoperative Bleeding in the Surgical Treatment of Cesarean Scar Pregnancy and Development of Predictive Models

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