Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, United Kingdom.
Clinic for Gynecology, University Medical Centre Maribor, Maribor, Slovenia.
Eur J Obstet Gynecol Reprod Biol. 2021 Sep;264:224-231. doi: 10.1016/j.ejogrb.2021.07.030. Epub 2021 Jul 22.
To evaluate the association between demographic and ultrasound variables and major intra-operative blood loss during surgical transcervical evacuation of live caesarean scar pregnancies.
This was a retrospective cohort study conducted in a tertiary referral center between 2008 and 2019. We included all women diagnosed with a live caesarean scar ectopic pregnancy who chose to have surgical management in the study center. A preoperative ultrasound was performed in each patient. All women underwent transcervical suction curettage under ultrasound guidance. Our primary outcome was the rate of postoperative blood transfusion. The secondary outcomes were estimated intra-operative blood loss (ml), rate of retained products of conception, need for repeat surgery, need for uterine artery embolization and hysterectomy rate. Descriptive statistics were used to describe the variables. Univariate and multivariable logistic regression models were constructed using the relevant covariates to identify the significant predictors for severe blood loss.
During the study period, 80 women were diagnosed with a live caesarean scar pregnancy, of whom 62 (78%) opted for surgical management at our center. The median crown-rump length was 9.3 mm (range 1.4-85.7). Median blood loss at the time of surgery was 100 ml (range, 10-2300), and six women (10%; 95%CI 3.6-20) required blood transfusion. Crown-rump length and presence of placental lacunae were significant predictive factors for the need for blood transfusion and blood loss > 500 ml at univariate analysis (p < .01); on multivariate analysis, only crown-rump length was a significant predictor for need for blood transfusion (OR = 1.072; 95% CI 1.02-1.11). Blood transfusion was required in 6/18 (33%) cases with the crown-rump length ≥ 23 mm (≥9 weeks of gestation), but in none of 44 women presenting with a crown-rump length < 23 mm (p < .01).
The risk of severe intraoperative bleeding and need for blood transfusion during or after surgical evacuation of live caesarean scar pregnancies increases with gestational age and is higher in the presence of placental lacunae. One third of women presenting at ≥ 9 weeks of gestation required blood transfusion and their treatment should be ideally arranged in specialized tertiary centers.
评估人口统计学和超声变量与经宫颈清除活剖宫产瘢痕妊娠术中主要失血量之间的关系。
这是一项 2008 年至 2019 年在三级转诊中心进行的回顾性队列研究。我们纳入了所有选择在研究中心进行手术治疗的活剖宫产瘢痕部位妊娠的妇女。每位患者均进行术前超声检查。所有患者均在超声引导下行经宫颈吸引刮宫术。我们的主要结局是术后输血率。次要结局包括估计术中失血量（ml）、妊娠产物残留率、需要再次手术、需要子宫动脉栓塞术和子宫切除术率。采用描述性统计方法描述变量。使用相关协变量构建单变量和多变量逻辑回归模型，以确定严重出血的显著预测因素。
在研究期间，80 名妇女被诊断为活剖宫产瘢痕妊娠，其中 62 名（78%）选择在我们中心进行手术治疗。头臀长中位数为 9.3mm（范围 1.4-85.7）。手术时中位出血量为 100ml（范围 10-2300），6 名妇女（10%；95%CI 3.6-20）需要输血。头臀长和胎盘腔隙的存在是输血和出血量>500ml 的单变量分析的显著预测因素（p<.01）；多变量分析显示，只有头臀长是输血需求的显著预测因素（OR=1.072；95%CI 1.02-1.11）。在头臀长≥23mm（≥9 孕周）的 18 例患者中，有 6 例（33%）需要输血，但在头臀长<23mm 的 44 例患者中，无一例需要输血（p<.01）。
经宫颈清除活剖宫产瘢痕妊娠术中严重出血和输血的风险随孕龄增加而增加，且胎盘腔隙存在时风险更高。三分之一的妊娠≥9 周的妇女需要输血，她们的治疗应在专门的三级中心进行。
