Clinical and Experimental Obstetrics & Gynecology (Oct 2023)

Treatment of Early Cesarean Scar Pregnancy with Double Balloon Catheter: A Systematic Review of the Literature

  • Irene Passerini,
  • Francesco Marasciulo,
  • Federico Prefumo,
  • Anna Fichera,
  • Nicola Fratelli,
  • Filippo Alberto Ferrari,
  • Federico Ferrari,
  • Franco Odicino

DOI
https://doi.org/10.31083/j.ceog5010222
Journal volume & issue
Vol. 50, no. 10
p. 222

Abstract

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Background: Cesarean scar pregnancy (CSP) is a pregnancy in the scar area or “niche” from a prior hysterotomy, usually from a cesarean section. Currently, there is no consensus on the best management of CSP. A recent proposed treatment consists in placing a cervical ripening double-balloon catheter in the uterus under ultrasound guidance. Methods: In this systematic review on cervical ripening double-balloon catheter (CRDBC) treatment for CSP, we performed a literature search in electronic databases (Scopus, PubMed, MEDLINE, and Cochrane Library), from their inception until April 2023. The review was written following PRISMA guidelines for systematic reviews. Results: We identified 30 studies, and we finally analyzed 5 studies that met the inclusion criteria (one case report, two retrospective case series studies, a retrospective cohort study, and a retrospective multicentric case series). The total of pregnancies treated with CRDBC is 71, of which 8 (11%) were cervical pregnancies. The gestational age at treatment ranges from 5 + 0 to 10 + 1 gestational weeks, with variable human chorionic gonadotropin (hCG) levels (433–64.700 IU/mL). Most of the patients (73%) received adjuvant systemic methotrexate (MTX) and the catheter dwell time ranges from 1 to 5 days. Treatment was successful in all the patients. Maternal complications, defined as the need for transfusion, vaginal bleeding resulting in readmission, or requiring further treatment occurred in a small number of patients (4.2%). Conclusions: CRDBC was successful in the treatment of early CSPs. The effectiveness and safety of this minimally invasive method is testified to a small rate of maternal complications. Further prospective studies are warranted to explore this treatment modality. The study was registered on INPLASY (https://inplasy.com/), registration number: INPLASY202390070 (doi: 10.37766/inplasy2023.9.0070).

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