Bhalwal Asha, Agarwal Neha, Mohr-Sasson Aya
Division of Advanced Minimally Invasive Gynecological Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth McGovern Medical School, University of Texas Health Science Center, 6410 Fannin Street, MSB 2.250, Houston, TX, 77030, USA.
Sackler Medical School, Tel-Aviv University, 52621, Tel-Aviv, Israel.
Arch Gynecol Obstet. 2024 Dec;310(6):3139-3145. doi: 10.1007/s00404-024-07782-x. Epub 2024 Oct 26.
To compare the characteristics and outcomes of non-surgical and surgical treatments for Cesarean scar pregnancy (CSP).
A retrospective study conducted at a tertiary university affiliated medical center, including all women diagnosed with Cesarean scar pregnancy between 2019 and 2023. Women treated non-surgically (including: methotrexate, uterine artery embolization and balloon catheter) were compared to women treated surgically (including: hysterectomy, hysteroscopy and excision of the pregnancy with or without uterine niche repair). Demographic information, medical history, obstetric and gynecological characteristics, presenting symptoms, imaging findings, management details, surgical characteristics, and follow-up data were collected from the women's electronic medical records. Primary outcome was defined as the β-hCG levels on follow-up visit at 2 weeks following treatment.
42 women were diagnosed with Cesarean scar pregnancy during the study period, of them 9 (21%) were treated non-surgically and 33 (79%) were treated surgically. Median age was 33 (30-36) year old and median BMI was 31 (27-35) kg/m, with no statistical differences in-between the groups. Most of the women had previous two Cesarean sections (n = 12, 28%). 63% of the women were asymptomatic at the time of diagnosis. On transvaginal ultrasound examination, embryo was demonstrated in 66.7% and cardiac activity was observed in 75%. The median gestational age at diagnosis and β-hCG levels were comparable between the non-surgical and surgical treatment groups (p = 0.22, p = 0.61, respectively). In the surgical arm, the most common surgical procedure was excision of the pregnancy with uterine niche repair, that was performed in 14/42 (33%) of the women. Median hospitalization length was 3 (1-4) and 2 (1-3) days, for the non-surgical and surgical treatment groups, respectively (p = 0.51). The hemoglobin level before discharge was similar between the groups (p = 0.20). Only one woman in each group visited the emergency room before the follow-up visit (p = 0.31). β-hCG levels on follow-up were significantly lower in the surgical group compared to the non-surgical (p = 0.02).
Cesarean scar pregnancy can be asymptomatic and should be suspected to enable early diagnosis. Both non-surgical and surgical treatments are viable options, with comparable hospitalization lengths; however, the surgical intervention group is expected to show a significantly faster decrease in β-hCG levels.
比较剖宫产瘢痕妊娠（CSP）非手术治疗和手术治疗的特点及结局。
在一所大学附属医院进行的一项回顾性研究，纳入2019年至2023年期间所有诊断为剖宫产瘢痕妊娠的女性。将接受非手术治疗（包括：甲氨蝶呤、子宫动脉栓塞和球囊导管）的女性与接受手术治疗（包括：子宫切除术、宫腔镜检查以及妊娠物切除伴或不伴子宫憩室修复）的女性进行比较。从女性的电子病历中收集人口统计学信息、病史、妇产科特征、症状表现、影像学检查结果、治疗细节、手术特点及随访数据。主要结局定义为治疗后2周随访时的β - hCG水平。
研究期间42例女性被诊断为剖宫产瘢痕妊娠，其中9例（21%）接受非手术治疗，33例（79%）接受手术治疗。中位年龄为33（30 - 36）岁，中位BMI为31（27 - 35）kg/m²，两组间无统计学差异。大多数女性既往有两次剖宫产史（n = 12，28%）。63%的女性在诊断时无症状。经阴道超声检查，66.7%可见胚胎，75%观察到心搏。非手术治疗组和手术治疗组诊断时的中位孕周及β - hCG水平相当（p分别为0.22和0.61）。手术组中，最常见的手术方式是妊娠物切除伴子宫憩室修复，14/42（33%）的女性接受了该手术。非手术治疗组和手术治疗组的中位住院天数分别为3（1 - 4）天和2（1 - 3）天（p = 0.51）。两组出院前血红蛋白水平相似（p = 0.20）。每组仅1名女性在随访前到急诊室就诊（p = 0.31）。手术组随访时的β - hCG水平显著低于非手术组（p = 0.02）。
剖宫产瘢痕妊娠可能无症状，应提高警惕以实现早期诊断。非手术和手术治疗都是可行的选择，住院天数相当；然而，手术干预组的β - hCG水平下降预计明显更快。
