Fu Peiying, Zhang Ling, Zhou Ting, Wang Shixuan, Liu Ronghua
Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
Int J Gen Med. 2024 Jan 16;17:115-126. doi: 10.2147/IJGM.S445327. eCollection 2024.
Cesarean scar pregnancy (CSP) is an uncommon form of ectopic pregnancy that carries the risk of severe bleeding. To date, there has not been a universally accepted classification and treatment strategy. We performed this study to establish a risk scoring system and new CSP classification system for CSP and evaluate its efficacy.
A total of five groups were generated based on different methods of treatment, and the factors that increase the risk of intraoperative bleeding were examined in our center from 2013 to 2018. The construction of a risk scoring system in this study was based on the use of the chi-square test and multivariate logistic regression analysis. To determine the appropriate cutoff scores, receiver operating characteristic (ROC) curves and the area under the curve (AUC) were generated.
We identified the main high-risk factors for excessive intraoperative hemorrhage during CSP surgery through univariate and multivariate analyses. Within this investigation, the risk factors included gestational sac location and gestational sac diameter. Through analysis, an optimal cutoff score of 3 was determined, and the area under the ROC curve was calculated to be 0.8113 (95% CI=0.7696-0.8531). A score ranging from 0-3 was classified as low risk, while a score ranging from 5-7 was classified as high risk. Additionally, a new classification system for CSP has been established based on sonographic parameters. We also established a diagnostic and treatment process for CSP patients according to the risk scoring method and new CSP classification.
We identified the high-risk factors associated with bleeding during CSP surgery and developed a scoring system incorporating these factors. The utilization of this novel CSP typing method, in conjunction with the risk scoring system, can effectively inform doctors in their decision-making process concerning treatment strategies for patients with CSP.
剖宫产瘢痕妊娠（CSP）是一种少见的异位妊娠形式，存在严重出血风险。迄今为止，尚无普遍接受的分类和治疗策略。我们开展本研究以建立CSP的风险评分系统和新的CSP分类系统并评估其有效性。
基于不同治疗方法共分为五组，于2013年至2018年在我们中心研究增加术中出血风险的因素。本研究中风险评分系统的构建基于卡方检验和多因素逻辑回归分析。为确定合适的截断分数，绘制了受试者工作特征（ROC）曲线并计算曲线下面积（AUC）。
通过单因素和多因素分析，我们确定了CSP手术期间术中出血过多的主要高危因素。在本次调查中，危险因素包括孕囊位置和孕囊直径。通过分析，确定最佳截断分数为3，计算出ROC曲线下面积为0.8113（95%CI=0.7696-0.8531）。0至3分被归类为低风险，而5至7分被归类为高风险。此外，基于超声参数建立了一种新的CSP分类系统。我们还根据风险评分方法和新的CSP分类为CSP患者建立了诊断和治疗流程。
我们确定了与CSP手术期间出血相关的高危因素，并开发了纳入这些因素的评分系统。这种新型CSP分型方法与风险评分系统相结合，可有效帮助医生在为CSP患者制定治疗策略时进行决策。
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