{
    "abstract": "Cesarean scar pregnancy (CSP), a distinct form of ectopic pregnancy, presents challenges in effective management. It is categorized into three subtypes according to the location of placental implantation and the thickness of the myometrium at the uterine scar. Nevertheless, the optimal choice of treatment modalities for these subtypes remains largely unexamined.\nIn this retrospective analysis, we investigated the cases of 130 patients diagnosed with CSP who underwent diverse treatment approaches, namely ultrasound-guided dilation and curettage (D&C), hysteroscopic surgery alone or in combination with laparoscopic surgery (HCoLC), or uterine artery embolization (UAE) followed by curettage. Clinical data were meticulously retrieved from medical records and follow-up data, and a comparative analysis of relevant indicators was carried out across the different CSP subtypes.\nFrom January 2017 to December 2021, 35 patients underwent D&C, 85 underwent HCoLC, and 10 received UAE as a pretreatment. In the D&C group, the success rates for Type I and Type II CSP were 64.29% (18/28) and 14.28% (1/7), respectively. Significant differences were observed between the success and failure groups in terms of gestational sac size and clinical classification. Compared to Type I CSP, Type II CSP exhibited significantly longer surgical durations and higher hospitalization costs (P\u2009<\u20090.05). Three patients classified as Type III underwent simultaneous hysteroscopic evacuation of cesarean scar pregnancy and laparoscopic repair of the cesarean scar defect, achieving a 100% success rate in their initial treatment. HCoLC showed no significant differences in surgical duration and hospitalization costs but had higher success rates and shorter hospital stays compared to the D&C and UAE groups (P\u2009<\u20090.05). The UAE group had significantly longer surgical durations, higher hospitalization costs, and a higher incidence of postoperative complications (P\u2009<\u20090.05). However, these factors did not result in improved surgical success rates.\nThe classification of CSP and the measurement of gestational sac are of crucial importance in determining the most appropriate surgical intervention strategy. For patients diagnosed with Type I CSP, D&C and hysteroscopy are reliable treatment choices. In cases with larger gestational sacs or Type II CSP, hysteroscopy, either alone or in combination with laparoscopy, is regarded as a reliable and effective treatment approach. In patients with type III CSP, lesion excision with uterine repair is the recommended treatment.",
    "authors": [
        {
            "affiliation": "Department of Obstetrics and Gynecology, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, 215200, China.",
            "firstname": "Ruyue",
            "initials": "R",
            "lastname": "Ma"
        },
        {
            "affiliation": "Jiangsu Institute of Hematology, The First Affiliated Hospital and Collaborative Innovation Center of Hematology, Key Laboratory of Thrombosis and Hemostasis of National Health Commission, Suzhou, 215006, China.",
            "firstname": "Shuang",
            "initials": "S",
            "lastname": "Chen"
        },
        {
            "affiliation": "Department of Ultrasound, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, 215200, China.",
            "firstname": "Weihua",
            "initials": "W",
            "lastname": "Xu"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, 215200, China.",
            "firstname": "Ruirui",
            "initials": "R",
            "lastname": "Zhang"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, 215200, China.",
            "firstname": "Yu",
            "initials": "Y",
            "lastname": "Zheng"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, 215200, China.",
            "firstname": "Jianing",
            "initials": "J",
            "lastname": "Wang"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, 215200, China. leizhanggyn@outlook.com.\nDepartment of Obstetrics and Gynecology, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, No. 2666 Ludang Road, Wujiang District, Suzhou, 215000, P.R. China. leizhanggyn@outlook.com.",
            "firstname": "Lei",
            "initials": "L",
            "lastname": "Zhang"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, 200240, China. chenrujun@fudan.edu.cn.\nDepartment of Gynecology and Obstetrics, Shanghai Fifth People's Hospital, Fudan University, No. 801 Heqing Road, Minhang District, Shanghai, 200240, P.R. China. chenrujun@fudan.edu.cn.",
            "firstname": "Rujun",
            "initials": "R",
            "lastname": "Chen"
        }
    ],
    "conclusions": "The classification of CSP and the measurement of gestational sac are of crucial importance in determining the most appropriate surgical intervention strategy. For patients diagnosed with Type I CSP, D&C and hysteroscopy are reliable treatment choices. In cases with larger gestational sacs or Type II CSP, hysteroscopy, either alone or in combination with laparoscopy, is regarded as a reliable and effective treatment approach. In patients with type III CSP, lesion excision with uterine repair is the recommended treatment.",
    "copyrights": "\u00a9 2024. The Author(s).",
    "doi": "10.1186/s12884-024-06887-0",
    "journal": "BMC pregnancy and childbirth",
    "keywords": [
        "Cesarean scar pregnancy",
        "Hysteroscopy",
        "Laparoscopy",
        "Uterine artery embolization",
        "Uterine scar repair"
    ],
    "methods": null,
    "publication_date": "2024-10-22",
    "pubmed_id": "39433995\n34130991\n22464076\n16738166\n15027012\n12666214\n33959686\n31943529\n31972162\n31677755\n37356119\n26979630\n33168010\n28268103\n24769010\n37023450\n27561933\n34249974\n31689823\n10817886\n19155928\n25191196\n29391803\n35046710\n26764166\n32600442\n31172522\n17364288\n28179198\n24656888\n30572017\n34301391\n28599886\n34194390",
    "results": "From January 2017 to December 2021, 35 patients underwent D&C, 85 underwent HCoLC, and 10 received UAE as a pretreatment. In the D&C group, the success rates for Type I and Type II CSP were 64.29% (18/28) and 14.28% (1/7), respectively. Significant differences were observed between the success and failure groups in terms of gestational sac size and clinical classification. Compared to Type I CSP, Type II CSP exhibited significantly longer surgical durations and higher hospitalization costs (P\u2009<\u20090.05). Three patients classified as Type III underwent simultaneous hysteroscopic evacuation of cesarean scar pregnancy and laparoscopic repair of the cesarean scar defect, achieving a 100% success rate in their initial treatment. HCoLC showed no significant differences in surgical duration and hospitalization costs but had higher success rates and shorter hospital stays compared to the D&C and UAE groups (P\u2009<\u20090.05). The UAE group had significantly longer surgical durations, higher hospitalization costs, and a higher incidence of postoperative complications (P\u2009<\u20090.05). However, these factors did not result in improved surgical success rates.",
    "title": "Surgical treatment of cesarean scar pregnancy based on the three-category system: a retrospective analysis.",
    "xml": "<Element 'PubmedArticle' at 0x7885044083b0>"
}