Yuan Zhang1,2,3, Zhongyun Zhang4,5, Xiaoyan Liu6, Lei Zhang7, Fanzhen Hong7, Ming Lu8,9,10. 1. School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China. 2. Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, China. 3. Clinical Research Center, Shandong University, Jinan, China. 4. Department of Endocrinology and Metabolism, Ruijin Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai, China. 5. School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China. 6. Department of Obstetrics, Qilu Hospital of Shandong University, Jinan, China. 7. Department of Obstetrics, Second Hospital of Shandong University, Jinan, China. 8. School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China. lvming@sdu.edu.cn. 9. Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, China. lvming@sdu.edu.cn. 10. Clinical Research Center, Shandong University, Jinan, China. lvming@sdu.edu.cn.
Abstract
PURPOSE: Cesarean scar pregnancy (CSP) is one of the serious complications associated with cesarean delivery (CD). This meta-analysis aims to identify risk factors associated with massive hemorrhage during the CSP treatment. METHODS: Eight electronic databases were searched for case-control studies published before December 31th, 2018, which compared the possible factors causing massive bleeding during the CSP treatment. Quantitative synthesis was performed by RevMan 5.3. Sensitivity analysis and publication bias were performed by Stata 12.0. RESULTS: Total 20 case - control studies including 3101 CSP patients with previous CD met the inclusion criteria. Bleeding group had 573 patients and the control group had 2528 patients. The risk factors for massive bleeding during CSP treatment included multiple gravidities (MD = 0.15, 95% CI 0.03-0.28, P = 0.73), big maximum diameter of gestation sac (MD = 18.49 mm, 95%CI 15.34-21.65, P < 0.01), high gestational days (MD = 8.98 days, 95% CI 4.12-13.84, P < 0.01), high β-HCG level (MD = 21.39 IU/ml, 95% CI 7.36-35.41, P = 0.03; MD = 3.02 U/ml, 95% CI 0.21-5.84, P < 0.01) and rich blood flow around the lesion (OR = 6.73, 95% CI 3.93-11.51, P = 0.59). While, thick myometrium (MD = - 4.94 mm, 95% CI - 6.12 to - 3.75, P < 0.01) may be protective factor. CONCLUSIONS: Multiple gravidities, big gestation sac, large gestational days, high serum β-HCG level, abundant blood supply to pregnancy sac and thin myometrium maybe the risk factors for massive bleeding during the CSP treatment.
PURPOSE: Cesarean scar pregnancy (CSP) is one of the serious complications associated with cesarean delivery (CD). This meta-analysis aims to identify risk factors associated with massive hemorrhage during the CSP treatment. METHODS: Eight electronic databases were searched for case-control studies published before December 31th, 2018, which compared the possible factors causing massive bleeding during the CSP treatment. Quantitative synthesis was performed by RevMan 5.3. Sensitivity analysis and publication bias were performed by Stata 12.0. RESULTS: Total 20 case - control studies including 3101 CSPpatients with previous CD met the inclusion criteria. Bleeding group had 573 patients and the control group had 2528 patients. The risk factors for massive bleeding during CSP treatment included multiple gravidities (MD = 0.15, 95% CI 0.03-0.28, P = 0.73), big maximum diameter of gestation sac (MD = 18.49 mm, 95%CI 15.34-21.65, P < 0.01), high gestational days (MD = 8.98 days, 95% CI 4.12-13.84, P < 0.01), high β-HCG level (MD = 21.39 IU/ml, 95% CI 7.36-35.41, P = 0.03; MD = 3.02 U/ml, 95% CI 0.21-5.84, P < 0.01) and rich blood flow around the lesion (OR = 6.73, 95% CI 3.93-11.51, P = 0.59). While, thick myometrium (MD = - 4.94 mm, 95% CI - 6.12 to - 3.75, P < 0.01) may be protective factor. CONCLUSIONS: Multiple gravidities, big gestation sac, large gestational days, high serum β-HCG level, abundant blood supply to pregnancy sac and thin myometrium maybe the risk factors for massive bleeding during the CSP treatment.
Authors: Aya Y Michaels; Erin E Washburn; Katherine D Pocius; Carol B Benson; Peter M Doubilet; Daniela A Carusi Journal: J Ultrasound Med Date: 2015-04 Impact factor: 2.153
Authors: Manuel Sánchez-Prieto; María Jesús Puy; Núria Barbany; Betlem Graupera; Maria Angela Pascual; Pere Barri-Soldevila Journal: Case Rep Obstet Gynecol Date: 2022-06-22