Risk factors associated with failure of treatment for cesarean scar pregnancy
Journal
International Journal of Gynecology and Obstetrics
Journal Volume
138
Journal Issue
1
Pages
28-36
Date Issued
2017
Abstract
Objective: To identify risk factors associated with treatment failure among women with cesarean scar pregnancy (CSP). Methods: In a retrospective study, the medical records of patients with CSP treated at National Taiwan University Hospital, Taipei, Taiwan, from 1994 to 2015 were reviewed. The women were managed primarily with hysterotomy, evacuation, or methotrexate. Receiver operating characteristic (ROC) curve analysis and logistic regression analysis were used to evaluate the factors associated with treatment failure. Results: Among 90 patients, 44 underwent hysterotomy, 18 underwent evacuation, and 28 received methotrexate. The success rates were 100% (44/44) for hysterotomy, 83% (15/18) for evacuation, and 57% (16/28) for methotrexate (P<0.001). ROC curve analysis indicated that a pregnancy length of 8?weeks and a mean sac diameter (MSD) of 4?cm were both predictive of failure of treatment by primary evacuation and methotrexate. In multivariate logistic regression analysis, an MSD of 4?cm or more was the only independent risk factor for treatment failure (odds ratio 68.99, 95% confidence interval 6.27–759.60; P=0.001). Conclusion: Primary hysterotomy was suitable for treatment of CSP of any size. Failure of primary evacuation or methotrexate usually occurred when the MSD was larger than 4?cm. ? 2017 International Federation of Gynecology and Obstetrics
Other Subjects
chorionic gonadotropin; hemoglobin; methotrexate; abortive agent; methotrexate; abdominal pain; adult; Article; carcinogenesis; cesarean scar pregnancy; cesarean section; curettage; female; follow up; hemoglobin blood level; human; hysterectomy; hysterotomy; incidental finding; major clinical study; medical record review; operative blood loss; pregnancy disorder; priority journal; recurrent disease; retrospective study; risk factor; scar; treatment duration; treatment failure; treatment outcome; vagina bleeding; adverse effects; cesarean section; comparative study; complication; diagnostic imaging; fetus echography; middle aged; pregnancy; Pregnancy, Ectopic; scar; young adult; Abortifacient Agents, Nonsteroidal; Adult; Cesarean Section; Cicatrix; Female; Humans; Hysterotomy; Methotrexate; Middle Aged; Pregnancy; Pregnancy, Ectopic; Retrospective Studies; Risk Factors; Treatment Failure; Ultrasonography, Prenatal; Young Adult
Publisher
Wiley Blackwell
Type
journal article