H M Harb1, M Knight2, C Bottomley3, C Overton4, A Tobias1, I D Gallos1, M Shehmar5, R Farquharson6, A Horne7, P Latthe1, E Edi-Osagie8, M MacLean9, E Marston10, J Zamora11, F Dawood6, R Small12, J Ross13, T Bourne14, A Coomarasamy1, D Jurkovic15. 1. Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK. 2. National Perinatal Epidemiology Unit, Oxford, UK. 3. Chelsea and Westminster Hospital, London, UK. 4. St Michael's Hospital, Bristol, UK. 5. Birmingham Women's Hospital, Edgbaston, UK. 6. Liverpool Women's Hospital, Liverpool, UK. 7. The Queen's Medical Research Institute, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, UK. 8. Central Manchester University Hospitals, Saint Mary's Hospital, Manchester, UK. 9. NHS Ayrshire and Arran, Crosshouse Hospital, Kilmarnock, Ayrshire, UK. 10. College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK. 11. Hospital Ramon y Cajal, Madrid, Spain. 12. Heart of England NHS Foundation Trust, Heartlands Hospital, Bordesley Green East, UK. 13. King's College Hospital, London, UK. 14. Tommy's National Centre for Miscarriage, Research, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK. 15. University College Hospital, London, UK.
Abstract
OBJECTIVE: To estimate the incidence of caesarean scar pregnancy (CSP) and to describe the management outcomes associated with this condition. DESIGN: A national cohort study using the UK Early Pregnancy Surveillance Service (UKEPSS). SETTING: 86 participating Early Pregnancy Units. POPULATION: All women diagnosed in the participating units with CSP between November 2013 and January 2015. METHODS: Cohort study of women identified through the UKEPSS monthly mailing system. MAIN OUTCOME MEASURES: Incidence, clinical outcomes and complications. RESULTS: 102 cases of CSP were reported, with an estimated incidence of 1.5 per 10 000 (95% CI 1.1-1.9) maternities. Full outcome data were available for 92 women. Management was expectant in 21/92 (23%), medical in 15/92 (16%) and surgical in 56/92 (61%). The success rates of expectant, medical and surgical management were 43% (9/21), 46% (7/15) and 96% (54/56), respectively. The complication rates were 15/21 (71%) with expectant, 9/15 (60%) with medical and 20/56 (36%) with surgical management. Discharge from care (median number of days) was 82 (range 37-174) with expectant, 21 (range 10-31) with medical and 11 (range 4-49) with surgical management. CONCLUSIONS: Surgical management appears to be associated with a high success rate, low complication rate and short post-treatment follow up. TWEETABLE ABSTRACT: Surgery for CSP appears to be successful, with low complication rates and short post-treatment follow up.
OBJECTIVE: To estimate the incidence of caesarean scar pregnancy (CSP) and to describe the management outcomes associated with this condition. DESIGN: A national cohort study using the UK Early Pregnancy Surveillance Service (UKEPSS). SETTING: 86 participating Early Pregnancy Units. POPULATION: All women diagnosed in the participating units with CSP between November 2013 and January 2015. METHODS: Cohort study of women identified through the UKEPSS monthly mailing system. MAIN OUTCOME MEASURES: Incidence, clinical outcomes and complications. RESULTS: 102 cases of CSP were reported, with an estimated incidence of 1.5 per 10 000 (95% CI 1.1-1.9) maternities. Full outcome data were available for 92 women. Management was expectant in 21/92 (23%), medical in 15/92 (16%) and surgical in 56/92 (61%). The success rates of expectant, medical and surgical management were 43% (9/21), 46% (7/15) and 96% (54/56), respectively. The complication rates were 15/21 (71%) with expectant, 9/15 (60%) with medical and 20/56 (36%) with surgical management. Discharge from care (median number of days) was 82 (range 37-174) with expectant, 21 (range 10-31) with medical and 11 (range 4-49) with surgical management. CONCLUSIONS: Surgical management appears to be associated with a high success rate, low complication rate and short post-treatment follow up. TWEETABLE ABSTRACT: Surgery for CSP appears to be successful, with low complication rates and short post-treatment follow up.
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