Clinical Characteristics and Management of Different Types of Cesarean Scar Pregnancy

Abstract

Background The current classification of cesarean scar pregnancy (CSP) is only based on the ultrasonic characteristics. At present, there is a lack of analysis and summarization of the clinical characteristics of different types of CSP cases under this classification criteria. Objective To investigate the clinical characteristics and management variance of different types of CSP. Methods A total of 862 patients with CSP admitted to the Department of Obstetrics and Gynecology, Peking University Third Hospital from July 2014 to June 2022 were enrolled and divided into the type Ⅰ, type Ⅱ and type Ⅲ groups. The clinical characteristics and indicators of diagnosis and treatment were analyzed retrospectively. Results Among the total CSP patients, 36.5% (315/862) were typeⅠ, 53.1% (458/862) were typeⅡ, and 10.3% (89/862) were type Ⅲ. The incidence of abdominal pain was 24.2% (209/862) and vaginal bleeding was 65.0% (560/862) in CSP patients. There was no statistically significant difference in the age, history of pregnancy and childbirth, and proportion of previous uterine cavity surgery among the three groups of patients (P>0.05). There was no significant difference in abdominal pain (P=0.261) and vaginal bleeding (P=0.062) among the three groups. In typeⅢ patients, the average gestational age was 55 (46, 64) days, the average diameter of gestational mass was 29.6 (19.1, 43.3) mm, and the serum β-HCG level was 60 673 (17 164, 122 203) mU/mL at diagnosis. The proportion of patients who needed adjuvant pharmacologic embryocidal therapy, laparoscopic surgery and uterine artery occlusion was 27% (24/89), 33.7% (30/89) and 32.6% (29/89), respectively. The operation duration was 101 (67, 125) min, the hospitalization duration was 4 (3, 7) days, and the treatment cost was 11 933.7 (8 760.7, 15 250.6) CNY for typeⅢpatients. The accumulated bleeding volume within 24 hours after surgery, the proportion of patients with perioperative bleeding≥200 mL and requiring blood transfusion was 24.7% (22/89) and 7.9% (7/89) in typeⅢ patients, respectively, which were higher than the other two groups (P<0.001). The incidence of persistent CSP was 3.1% (27/862) in all patients, and there was no significant difference among the three groups (χ2=3.353, P=0.187) . Conclusion There is no significant difference in age, maternal history, gravidity and parity, and clinical characteristics such as abdominal pain and vaginal bleeding in patients with different types of CSP. The treatment of typeⅠand typeⅡpatients is less invasive and consumes less medical resources, while typeⅢpatients consume more medical resources and have high requirements for multidisciplinary team and individualized management. The prognosis of all three types of patients is ideal after standardized management.

Keywords

• cesarean section|scar pregnancy|signs and symptoms|treatment|prognosis