Cargando…

Management of persistent caesarean scar pregnancy after curettage treatment failure

BACKGROUND: Caesarean scar pregnancy (CSP) is a late serious complication of caesarean section. The incidence of CSP has increased worldwide in recent years. Early diagnosis and prompt therapy are crucial to avoid catastrophic complications. There are various strategies for CSP treatment, but there...

Descripción completa

Detalles Bibliográficos
Autores principales: Qian, Zhi-Da, Weng, Yue, Du, Yong-Jiang, Wang, Chun-Fen, Huang, Li-Li
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5493865/
https://www.ncbi.nlm.nih.gov/pubmed/28666477
http://dx.doi.org/10.1186/s12884-017-1395-4
_version_ 1783247580598108160
author Qian, Zhi-Da
Weng, Yue
Du, Yong-Jiang
Wang, Chun-Fen
Huang, Li-Li
author_facet Qian, Zhi-Da
Weng, Yue
Du, Yong-Jiang
Wang, Chun-Fen
Huang, Li-Li
author_sort Qian, Zhi-Da
collection PubMed
description BACKGROUND: Caesarean scar pregnancy (CSP) is a late serious complication of caesarean section. The incidence of CSP has increased worldwide in recent years. Early diagnosis and prompt therapy are crucial to avoid catastrophic complications. There are various strategies for CSP treatment, but there is no consensus on the best management for CSP. Dilation and curettage (D&C) and hysteroscopy are common and effective treatments with their advantages and disadvantages. No in-depth study of the clinical effects of hysteroscopic management of CSP after D&C treatment failure has been conducted. The purpose of this study is to evaluate the effectiveness and safety of hysteroscopic removal of residual CSP tissue (persistent CSP) as a rescue after failed D&C management. METHODS: This is a retrospective clinical research study. Forty-five patients underwent operative hysteroscopy to remove the residual gestational tissue in the caesarean scar after failed D&C treatment. The clinical characteristics and outcomes of hysteroscopic surgeries of 45 CSP cases were investigated. All data analyses were conducted with SPSS 17.0. RESULTS: Forty-three CSP cases after unsuccessful curettage treatment were successfully treated by operative hysteroscopy. The estimated intraoperative blood loss was 20.00 (10.00–500.00) mL, the hysteroscopic operating time was 20.00 (15.00–45.00) min, the decline of serum β-hCG the day after surgery was 71.91 ± 14.05%, the total hospitalisation time was 7.87 ± 2.26 days, the medical cost was 13,682.71 ± 3553.77 China Yuan (CNY), the time of bleeding after surgery was 7.42 ± 2.48 days, and the time of serum β-hCG resolution after surgery was 13.84 ± 9.83 days. Follow-up after discharge demonstrated that there were no severe complications for any patients. CONCLUSIONS: Hysteroscopy therapy could treat persistent CSP effectively and safely after curettage treatment failure. Therapy should be individualised, and the risks and cost of the hysteroscopy procedure and anaesthesia must be considered and fully discussed with the patients before surgery.
format Online
Article
Text
id pubmed-5493865
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-54938652017-07-05 Management of persistent caesarean scar pregnancy after curettage treatment failure Qian, Zhi-Da Weng, Yue Du, Yong-Jiang Wang, Chun-Fen Huang, Li-Li BMC Pregnancy Childbirth Research Article BACKGROUND: Caesarean scar pregnancy (CSP) is a late serious complication of caesarean section. The incidence of CSP has increased worldwide in recent years. Early diagnosis and prompt therapy are crucial to avoid catastrophic complications. There are various strategies for CSP treatment, but there is no consensus on the best management for CSP. Dilation and curettage (D&C) and hysteroscopy are common and effective treatments with their advantages and disadvantages. No in-depth study of the clinical effects of hysteroscopic management of CSP after D&C treatment failure has been conducted. The purpose of this study is to evaluate the effectiveness and safety of hysteroscopic removal of residual CSP tissue (persistent CSP) as a rescue after failed D&C management. METHODS: This is a retrospective clinical research study. Forty-five patients underwent operative hysteroscopy to remove the residual gestational tissue in the caesarean scar after failed D&C treatment. The clinical characteristics and outcomes of hysteroscopic surgeries of 45 CSP cases were investigated. All data analyses were conducted with SPSS 17.0. RESULTS: Forty-three CSP cases after unsuccessful curettage treatment were successfully treated by operative hysteroscopy. The estimated intraoperative blood loss was 20.00 (10.00–500.00) mL, the hysteroscopic operating time was 20.00 (15.00–45.00) min, the decline of serum β-hCG the day after surgery was 71.91 ± 14.05%, the total hospitalisation time was 7.87 ± 2.26 days, the medical cost was 13,682.71 ± 3553.77 China Yuan (CNY), the time of bleeding after surgery was 7.42 ± 2.48 days, and the time of serum β-hCG resolution after surgery was 13.84 ± 9.83 days. Follow-up after discharge demonstrated that there were no severe complications for any patients. CONCLUSIONS: Hysteroscopy therapy could treat persistent CSP effectively and safely after curettage treatment failure. Therapy should be individualised, and the risks and cost of the hysteroscopy procedure and anaesthesia must be considered and fully discussed with the patients before surgery. BioMed Central 2017-07-01 /pmc/articles/PMC5493865/ /pubmed/28666477 http://dx.doi.org/10.1186/s12884-017-1395-4 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Qian, Zhi-Da
Weng, Yue
Du, Yong-Jiang
Wang, Chun-Fen
Huang, Li-Li
Management of persistent caesarean scar pregnancy after curettage treatment failure
title Management of persistent caesarean scar pregnancy after curettage treatment failure
title_full Management of persistent caesarean scar pregnancy after curettage treatment failure
title_fullStr Management of persistent caesarean scar pregnancy after curettage treatment failure
title_full_unstemmed Management of persistent caesarean scar pregnancy after curettage treatment failure
title_short Management of persistent caesarean scar pregnancy after curettage treatment failure
title_sort management of persistent caesarean scar pregnancy after curettage treatment failure
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5493865/
https://www.ncbi.nlm.nih.gov/pubmed/28666477
http://dx.doi.org/10.1186/s12884-017-1395-4
work_keys_str_mv AT qianzhida managementofpersistentcaesareanscarpregnancyaftercurettagetreatmentfailure
AT wengyue managementofpersistentcaesareanscarpregnancyaftercurettagetreatmentfailure
AT duyongjiang managementofpersistentcaesareanscarpregnancyaftercurettagetreatmentfailure
AT wangchunfen managementofpersistentcaesareanscarpregnancyaftercurettagetreatmentfailure
AT huanglili managementofpersistentcaesareanscarpregnancyaftercurettagetreatmentfailure