Clinical and ultrasound parameters in prediction of excessive hemorrhage during management of cesarean scar pregnancy

PRECIS: During the management of cesarean scar pregnancy, gestational mass size >6 cm, uterine scar thickness <0.2 cm, peak systolic velocity >70 cm/s, and resistance index <0.35 are independent risk factors for excessive hemorrhage. OBJECTIVE: The objective of this study was to investigate risk factors associated with excessive hemorrhage during the management of cesarean scar pregnancy (CSP). PATIENTS AND METHODS: A retrospective case–control study was conducted, including 40 patients who experienced excessive bleeding and 80 controls without severe hemorrhage. RESULTS: Six parameters (two clinical and four ultrasound parameters) potentially related to excessive hemorrhage were analyzed. Single-variable statistical analyses showed that the case group had higher gestational age (74.1±23.6 days), higher pretreatment serum β-human chorionic gonadotropin (HCG) level (46,201±32,294 mIU/mL), larger gestational mass size (6.5±2.2 cm), thinner uterine scar thickness (0.17±0.12 cm), and richer peritrophoblastic perfusion (peak systolic velocity [PSV] 72.8±33.7 cm/s, resistance index [RI] 0.35±0.12), showing statistical significance compared with the control group. Further multivariable logistic regression analysis of the association between each of the risk factors and hemorrhage confirmed that increased gestational mass size and PSV were risk factors for hemorrhage (odds ratio [OR] 3.624, 95% confidence interval [CI] [1.179–11.138] and OR 1.062, 95% CI [1.007–1.121]) and increased uterine scar thickness and RI were protective factors against hemorrhage (OR 0.181, 95% CI [0.034–0.957] and OR 0.851, 95% CI [0.729–0.994]); however, there was no statistical significance between the two clinical parameters. CONCLUSION: Gestational mass size >6 cm, uterine scar thickness <0.2 cm, PSV >70 cm/s, and RI <0.35 are independent risk factors for excessive hemorrhage during the management of CSP.