Feasibility of treatment of cesarean scar pregnancy with dilatation and curettage under ultrasound guidance

Abstract

The present study sought to investigate the predictors of successful dilatation and curettage (D&C) in treatment of cesarean scar pregnancy (CSP). Retrospective analysis was conducted in 84 CSP patients undergoing D&C from January 2013 to December 2014. Failure was defined as D&C followed by transcatheter uterine arterial embolization due to uncontrolled hemorrhage. Sub-stratification of success group as residue group or non-residue group was performed according to the residues at the site of cesarean scar after D&C. The univariate logistic regression and linear regression were used to assess the predictors of the failure and residues. ROC curve was used to assess the cut-off values of the predictors. D&C under ultrasound guidance succeeded in 75 patients (89.3%) and 36 patients had residues at the site of cesarean scar among them (48%), 9 patients failed in D&C (10.7%). High Serum human chorionic-gonadotropin (hCG), small gestation sac (GS), thin cesarean scar myometrium thickness (CSM) and low peritrophoblastic flow resistance index (RI) were risk factors of D&C failure in treatment of CSP. That serum hCG>97 006 U/L was prime predictor of failure (predictive value 100%, 95% CI 94.9%-100%). High success ratio was observed in patients with serum hCG<58 076 U/L, GS≤19 mm, CSM>2.7 mm, and RI>0.25. And days of menopause≤41 d, GS≤15 mm, CSM>3.7 mm, RI>0.4 and serum hCG<3 935 U/L were predictors of complete success of D&C. The postponed restoration of menstruation was observed in patients with residues, which did not induce amenorrhea and disappeared in 1-3 months after procedures. Early diagnosis and treatment is associated with successful D&C in treatment of CSP. HCG, GS, CSM and RI are valuable in predicting the prognosis of D&C in treatment of CSP.