Zhiyi Liang1, Jiying Su1, Hua Yang2. 1. Department of Family Planning, Central Hospital of Gynecology and Obstetrics, Tianjin 300052, China. 2. Department of Family Planning, Central Hospital of Gynecology and Obstetrics, Tianjin 300052, China; Email: huayangnv@126.com.
Abstract
OBJECTIVE: The present study sought to investigate the predictors of successful dilatation and curettage (D&C) in treatment of cesarean scar pregnancy (CSP). METHODS: Retrospective analysis was conducted in 84 CSP patients undergoing D&C from January 2013 to December 2014. Failure was defined as D&C followed by transcatheter uterine arterial embolization due to uncontrolled hemorrhage. Sub-stratification of success group as residue group or non-residue group was performed according to the residues at the site of cesarean scar after D&C. The univariate logistic regression and linear regression were used to assess the predictors of the failure and residues. ROC curve was used to assess the cut-off values of the predictors. RESULTS: D&C under ultrasound guidance succeeded in 75 patients (89.3%) and 36 patients had residues at the site of cesarean scar among them (48%), 9 patients failed in D&C (10.7%). High Serum human chorionic-gonadotropin (hCG), small gestation sac (GS), thin cesarean scar myometrium thickness (CSM) and low peritrophoblastic flow resistance index (RI) were risk factors of D&C failure in treatment of CSP. That serum hCG>97 006 U/L was prime predictor of failure (predictive value 100%, 95% CI 94.9%-100%). High success ratio was observed in patients with serum hCG<58 076 U/L, GS≤19 mm, CSM>2.7 mm, and RI>0.25. And days of menopause≤41 d, GS≤15 mm, CSM>3.7 mm, RI>0.4 and serum hCG<3 935 U/L were predictors of complete success of D&C. The postponed restoration of menstruation was observed in patients with residues, which did not induce amenorrhea and disappeared in 1-3 months after procedures. CONCLUSION: Early diagnosis and treatment is associated with successful D&C in treatment of CSP. HCG, GS, CSM and RI are valuable in predicting the prognosis of D&C in treatment of CSP.
OBJECTIVE: The present study sought to investigate the predictors of successful dilatation and curettage (D&C) in treatment of cesarean scar pregnancy (CSP). METHODS: Retrospective analysis was conducted in 84 CSP patients undergoing D&C from January 2013 to December 2014. Failure was defined as D&C followed by transcatheter uterine arterial embolization due to uncontrolled hemorrhage. Sub-stratification of success group as residue group or non-residue group was performed according to the residues at the site of cesarean scar after D&C. The univariate logistic regression and linear regression were used to assess the predictors of the failure and residues. ROC curve was used to assess the cut-off values of the predictors. RESULTS: D&C under ultrasound guidance succeeded in 75 patients (89.3%) and 36 patients had residues at the site of cesarean scar among them (48%), 9 patients failed in D&C (10.7%). High Serum humanchorionic-gonadotropin (hCG), small gestation sac (GS), thin cesarean scar myometrium thickness (CSM) and low peritrophoblastic flow resistance index (RI) were risk factors of D&C failure in treatment of CSP. That serum hCG>97 006 U/L was prime predictor of failure (predictive value 100%, 95% CI 94.9%-100%). High success ratio was observed in patients with serum hCG<58 076 U/L, GS≤19 mm, CSM>2.7 mm, and RI>0.25. And days of menopause≤41 d, GS≤15 mm, CSM>3.7 mm, RI>0.4 and serum hCG<3 935 U/L were predictors of complete success of D&C. The postponed restoration of menstruation was observed in patients with residues, which did not induce amenorrhea and disappeared in 1-3 months after procedures. CONCLUSION: Early diagnosis and treatment is associated with successful D&C in treatment of CSP. HCG, GS, CSM and RI are valuable in predicting the prognosis of D&C in treatment of CSP.