Department of Gynecology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, Fujian Province, China.
Department of Ultrasound, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, Fujian Province, China.
Ultrasound Obstet Gynecol. 2024 Apr;63(4):544-550. doi: 10.1002/uog.27459. Epub 2024 Feb 26.
To examine the value of the crossover sign (COS) in predicting treatment outcome in women with a Cesarean scar pregnancy (CSP) who were treated with ultrasound-guided vacuum aspiration.
This was a retrospective cohort study of women with CSP who underwent ultrasound-guided vacuum aspiration. Based on the relationship between the gestational sac, Cesarean scar and anterior wall of the uterus, CSPs were classified by COS type. Analysis was conducted to investigate the association between COS type (COS-1, COS-2) and treatment outcome. The incidence of treatment failure, retained pregnancy tissue, secondary therapy and bleeding ≥ 200 mL were analyzed.
In total, 181 eligible patients with CSP, including 90 (49.7%) women with COS-1 and 91 (50.3%) women with COS-2, were analyzed. COS-1 patients had a higher incidence of treatment failure compared with COS-2 patients (25.6% vs 8.8%; P = 0.003), as well as higher rates of retained pregnancy tissue (18.9% vs 6.6%; P = 0.013), secondary therapy (20.0% vs 6.6%; P = 0.002) and bleeding of ≥ 200 mL (13.3% vs 4.4%; P = 0.034). COS-1 and a large gestational sac (30.1-50.0 mm or >50.0 mm in diameter) were associated independently with increased risk of treatment failure (odds ratio, 4.57 (95% CI, 1.66-12.56); P = 0.003, 4.34 (95% CI, 1.35-13.94); P = 0.014 and 10.50 (95% CI, 2.54-43.46); P = 0.001, respectively).
Ultrasound evaluation of the relationship between the gestational sac and the endometrial line (COS classification) in women with CSP may help to predict treatment outcome among those undergoing vacuum aspiration. Among COS-1 patients, especially those with a gestational sac diameter of >30.0 mm, vacuum aspiration may be discouraged. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
探讨交叉征（COS）在经超声引导下真空抽吸治疗剖宫产瘢痕妊娠（CSP）患者中的预测价值。
这是一项回顾性队列研究，纳入了经超声引导下真空抽吸治疗的 CSP 患者。根据妊娠囊、剖宫产瘢痕与子宫前壁之间的关系，将 CSP 分为 COS 类型。分析 COS 类型（COS-1、COS-2）与治疗结局之间的关系。分析治疗失败、妊娠组织残留、二次治疗和出血量≥200ml 的发生率。
共纳入 181 例符合条件的 CSP 患者，其中 90 例（49.7%）为 COS-1 患者，91 例（50.3%）为 COS-2 患者。与 COS-2 患者相比，COS-1 患者的治疗失败发生率更高（25.6% vs. 8.8%；P=0.003），妊娠组织残留率（18.9% vs. 6.6%；P=0.013）、二次治疗率（20.0% vs. 6.6%；P=0.002）和出血量≥200ml 率（13.3% vs. 4.4%；P=0.034）也更高。COS-1 和较大的妊娠囊（30.1-50.0mm 或直径>50.0mm）与治疗失败的风险增加独立相关（比值比，4.57（95%CI，1.66-12.56）；P=0.003，4.34（95%CI，1.35-13.94）；P=0.014 和 10.50（95%CI，2.54-43.46）；P=0.001）。
超声评估 CSP 患者妊娠囊与子宫内膜线之间的关系（COS 分类）有助于预测真空抽吸治疗的结局。对于 COS-1 患者，特别是妊娠囊直径>30.0mm 的患者，应不鼓励采用真空抽吸。©2023 年国际妇产科超声学会。
