Characteristics of women with mixed mass formation after evacuation following uterine artery chemoembolization for cesarean scar pregnancy
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To explore the efficacy of treatment for early cesarean scar pregnancy (CSP) and to evaluate the characteristics of women with subsequent mixed mass formation.
Women with CSP, who received UACE followed by evacuation, were retrospectively analyzed. Clinical/sonographic characteristics in patients with or without mixed mass formation were compared.
From a total of 395 cases, 105 cases had a pregnancy residual with mixed mass formation. Blood loss and subsequent salvage intervention were significantly lower in patients without mixed mass, although all women retained their uteri. It required 50 days for the mass to resolve, 40 days for β-hCG concentrations to drop back to normal, and 61 days for menses to be restored; all of which were significantly longer than the same indices in women without a mixed mass. Clinical/sonographic characteristics predicting residual mass formation were maximal diameter of gestational sac (OR = 1.05, P = 0.001, with a sensitivity and specificity of 68.6 and 80.3%, respectively), presence of a fetal heart beat (OR = 2.63, P = 0.002, with a sensitivity and specificity of 62.9 and 67.2%, respectively), remnant myometrial thickness (OR = 108.91, P = 0.001 when thickness was less than 1 mm, with a sensitivity and specificity of 42.9% and 96.6%), location of gestational sac (OR = 59.20, P = 0.01 for complete type, with a sensitivity and specificity of 99.0 and 36.9%), and Doppler signal grading (OR = 8.08, P = 0.013 for Grade III, with a sensitivity and specificity of 83.8 and 51.0%).
UACE followed by evacuation was effective for CSP and subsequent mixed mass formation could be predicted by some clinical/sonographic characteristics.
KeywordsCesarean scar pregnancy Evacuation therapy Uterine artery chemoembolization
We thank for the ultrasonography team, who provided detailed and accurate sonographic information about the CSP cases.
Z-QC: project development and manuscript editing. Q-LS: manuscript editing. LL: data analysis. D-MY: data collection. XHW: data collection and manuscript writing YY: project development.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethics Committee of the Army Medical University, and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 1.Rotas MA, Haberman S, Levgur M (2006) Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol 107(6):1373–1381. https://doi.org/10.1097/01.AOG.0000218690.24494.ce CrossRefPubMedGoogle Scholar
- 8.Yin X, Su S, Dong B, Ban Y, Li C, Sun B (2012) Angiographic uterine artery chemoembolization followed by vacuum aspiration: an efficient and safe treatment for managing complicated cesarean scar pregnancy. Arch Gynecol Obstet 285(5):1313–1318. https://doi.org/10.1007/s00404-011-2132-2 CrossRefPubMedGoogle Scholar
- 9.Cheng LY, Wang CB, Chu LC, Tseng CW, Kung FT (2014) Outcomes of primary surgical evacuation during the first trimester in different types of implantation in women with cesarean scar pregnancy. Fertil Steril 102(4):1085–1090. https://doi.org/10.1016/j.fertnstert.2014.07.003 CrossRefPubMedGoogle Scholar
- 11.Pascual MA, Hereter L, Graupera B, Tresserra F, Fernandez-Cid M, Simon M (2007) Three-dimensional power Doppler ultrasound diagnosis and conservative treatment of ectopic pregnancy in a cesarean section scar. Fertil Steril 88(3):706. https://doi.org/10.1016/j.fertnstert.2006.11.183 CrossRefPubMedGoogle Scholar
- 14.Jurkovic D, Ben-Nagi J, Ofilli-Yebovi D, Sawyer E, Helmy S, Yazbek J (2007) Efficacy of Shirodkar cervical suture in securing hemostasis following surgical evacuation of Cesarean scar ectopic pregnancy. Ultrasound Obstet Gynecol 30(1):95–100. https://doi.org/10.1002/uog.4058 CrossRefPubMedGoogle Scholar
- 18.Gao L, Huang Z, Gao J, Mai H, Zhang Y, Wang X (2014) Uterine artery embolization followed by dilation and curettage within 24 hours compared with systemic methotrexate for cesarean scar pregnancy. Int J Gynaecol Obstet 127(2):147–151. https://doi.org/10.1016/j.ijgo.2014.05.005 CrossRefPubMedGoogle Scholar
- 19.Vial Y, Petignat P, Hohlfeld P (2000) Pregnancy in a cesarean scar. Ultrasound Obstet Gynecol 16(6):592–593. https://doi.org/10.1046/j.1469-0705.2000.00300-2.x CrossRefPubMedGoogle Scholar