Ultrasound-guided Suction Curettage Research Articles

Evaluation Effectiveness of Pre-Treatment Combined with Ultrasound-Guided Suction Curettage in Cesarean Scar Pregnancy: A Retrospective Cohort Study

Background: The objective of this study is to assess the effectiveness of ultrasound-guided suction curettage (UGSC) in conjunction with or without high-intensity focused ultrasound (HIFU) or uterine artery embolization (UAE) for the treatment of three distinct types of cesarean scar pregnancy (CSP). Methods: This was a retrospective study that included subjects diagnosed with CSP in a single tertiary referral centre from January 2015 to December 2020. UGSC associated with/without pretreatment was offered to CSP patients according to the location of pregnancy sac, the depth of implantation and the surrounding blood flowing. The data about baseline characteristics and outcome parameters were analyzed across the three groups. Results: The present study included 434 patients diagnosed with CSP. The majority were cured without severe complication except one case accepted blood transfusion. The baseline data from the three groups did not differ statistically. The UGSC group had the same successful rate of treating type I CSP with a shorter hospital stay (χ2 = 51.771, p = 0.000) compared to the HIFU or UAE groups. Type II CSP presented marked less blood loss (Z = –2.464, p = 0.014) and higher decline ration of beta-human chorionic gonadotropin (β-HCG) (Z = –4.728, p = 0.000) in HIFU group. Treatment success was high in patients with type III CSP in both the HIFU and UAE groups, but the rate of β-HCG decline was higher in the HIFU group (Z = –2.255, p = 0.024). Conclusions: This study suggests that UGSC is an effective and safe option for patients with low-risk CSP. HIFU or UAE combined with UGSC has higher efficacy in high-risk CSP. And HIFU may be superior in reducing bleeding and increasing the rate of β-HCG decline.

The value of ultrasound parameters in predicting the efficacy of transabdominal ultrasound-guided suction curettage alone in the treatment of cesarean scar pregnancy.

To investigate the value of ultrasound parameters in assessing the efficacy of transabdominal ultrasound (TAUS)-guided suction curettage alone for cesarean scar pregnancy (CSP). Secondary retrospective analysis of a prospective study consisted of 137 women diagnosed with CSP who were performed TAUS-guided suction curettage alone for the first time at Maternity and Child Health Care of Guangxi Zhuang Autonomous Region in China. Prior to surgery, an ultrasound examination was conducted. Based on the need for secondary intervention, the patients were categorized into failure group and success group, and the predictive factors for failure of TAUS-guided suction curettage alone were analyzed. Multivariate logistic regression showed that maximum diameter of the gestational sac>29 mm (odds ratio [OR] = 4.043, 95% CI: 1.100-14.862), residual myometrium thickness ≤1.8 mm (OR = 3.719, 95% CI: 1.148-12.048) and chorionic villi thickness at the scar >4.7 mm (OR = 15.327, 95% CI: 4.617-50.881) were independent predictors of failure in TAUS-guided suction curettage alone for CSP. Furthermore, the logistic regression model that was jointly constructed by these three predictors demonstrated an area under the curve, sensitivity, specificity, and Youden index of 0.913, 0.912, 0.864, and 0.776, respectively. The maximum diameter of the gestational sac, residual myometrium thickness, and chorionic villi thickness at the scar has certain predictive efficacy of TAUS-guided suction curettage alone for CSP. Nevertheless, it is more valuable to apply the model of this study, composed of the three ultrasound parameters, for this prediction purpose.

The effectiveness of hysteroscopy for the treatment of cesarean scar pregnancy: a retrospective cohort study

BackgroundCesarean scar pregnancy (CSP) is a long-term complication of cesarean section characterized by the localization of a subsequent gestational sac within the scar area or niche developed as a result of a previous cesarean section. Its incidence has increased substantially because of the high global cesarean section rate in recent decades. Several surgical and drug treatments exist for this condition; however, there is currently no optimal treatment. This study compared the effectiveness of direct hysteroscopic removal of the gestational tissue and hysteroscopy combined with vacuum suction for the treatment of CSP.MethodsFrom 2017 to 2023, 521 patients were diagnosed with CSP at our hospital. Of these patients, 45 underwent hysteroscopy. Among them, 28 underwent direct hysteroscopic removal (hysteroscopic removal group) and 17 underwent hysteroscopy combined with vacuum suction (hysteroscopic suction group). The clinical characteristics and outcomes of the hysteroscopic removal group and hysteroscopic suction group were analyzed.ResultsAmong the 45 patients, the amount of bleeding and hospitalization cost were significantly higher in the hysteroscopic removal group than in the hysteroscopic suction group (33.8 mL vs. 9.9 mL, P < 0.001; and 8744.0 yuan vs. 5473.8 yuan, P < 0.001; respectively). The operation time and duration of hospitalization were significantly longer in the hysteroscopic removal group than in the hysteroscopic suction group (61.4 min vs. 28.2 min, P < 0.001; and 3.8 days vs. 2.4 days, P = 0.026; respectively). Three patients in the hysteroscopic removal group had uterine perforation and received laparoscopic repair during operation. No complications occurred in the hysteroscopic suction group. One patient in the hysteroscopic removal group received ultrasound-guided suction curettage due to postoperative moderate vaginal bleeding, and one patient in the hysteroscopic suction group received ultrasound-guided suction curettage due to postoperative gestational residue and elevated serum beta-human chorionic gonadotropin levels. Reproductive function was preserved in all patients.ConclusionsHysteroscopy is an effective method for treating CSP. Compared with direct hysteroscopic removal, hysteroscopy combined with vacuum suction is more suitable for CSP. However, multicenter prospective studies with large sample sizes are required for verification of these findings.

Ultrasound-guided suction curettage followed by cervico-isthmic placement of foley threeway catheter for cesarean scar pregnancy's treatment. Retrospective study

ObjectivesCesarean scar pregnancy (CSP) is a rare dangerous condition with still no consensus on standard treatment. Suction curettage has been used as the first-line treatment for CSP with controversial outcomes. This study evaluates efficacy of ultrasound-guided suction curettage (UGSC) followed by cervical-isthmic placement of silicon semirigid three-way foley catheter. Materials and methodsThis study included 24 women with CSP. Preoperative ultrasound study was conducted. UGSC followed by placement of catheter was performed in all patients. The success rate and incidence of major complication, surgical time and hospital stay were recorded. ResultsThe success rate of UGSC followed by placement of foley catheter was 100 %, effectively reduced major complications and none of the patients had a blood loss higher than 900 ml. Median hospital stay was 2 days and median foley stay was 1 day. Surgery had limited last with a median of 17 min. ConclusionUGSC followed by foley placement is a safe effective treatment for CSP with a clinical resolution of 100 %. The catheter is easy to place under ultrasound guidance and prevents bleeding, reducing major procedures to solve the bleeding. Suction curettage in CSP treatment should be performed under ultrasound guidance and followed by cervical-isthmic placement of foley balloon.

Comparison of menstruation recovery after ultrasound-guided suction curettage in patients with cesarean scar pregnancy pretreated using high-intensity focused ultrasound and uterine artery embolization

Objectives To investigate the menstruation recovery after two therapeutic regimens, high-intensity focused ultrasound (HIFU) or uterine artery embolization (UAE) combined with ultrasound-guided suction curettage, for premenopausal women with cesarean scar pregnancy (CSP). Materials and methods Seventy patients with CSP treated with HIFU followed by ultrasound-guided suction curettage and 63 patients with CSP treated with UAE followed by ultrasound-guided suction curettage in our hospital were retrospectively reviewed. The treatment parameters and the menstrual blood loss (MBL) volume at 6 months after the two therapeutic regimens were compared between the two groups. Results There was no significant difference in treatment results between the two groups. With regard to postoperative MBL volume, 5 out of 70 patients in the HIFU group and 22 out of 63 patients in UAE group exhibited a reduction in MBL, respectively. Multivariate logistic regression revealed that hypomenorrhea was more likely to occur in the UAE group than in the HIFU group (UAE group vs. HIFU group; OR 11.328, 95% CI 3.158–55.871; p < 0.001). Conclusion Compared to UAE, HIFU has less influence on postoperative MBL volume, which may be a fertility-sparing option for patients with CSP.

Clinical efficacy and risk factors for suction curettage and hysteroscopy in patients with type I and II cesarean scar pregnancy.

To investigate the clinical efficacy and evaluate risk factors for suction curettage (SC) and hysteroscopy in the treatment of type I and II cesarean scar pregnancy (CSP). This was a retrospective study including 100 women diagnosed with type I/II CSP. Patients were treated with either ultrasound-guided SC (SC group) or hysteroscopy resection (surgery group). The success rates, mean operation time, hospitalization duration, hospitalization cost, risk factors, adverse events, and complications were analyzed. The success rate of the SC and surgery groups were 85% and 100%, respectively, and the difference was statistically significant (P = 0.032). There was one case of type I CSP and eight cases of type II CSP that failed SC treatment. No failed cases were found in the surgery group. Analysis of the causes of treatment failure revealed that diameter of the gestational sac was a risk factor for SC failure (odds ratio, 19.66 [95% confidence interval {CI}, 1.70-227.72], P = 0.017). Comparing the clinical outcomes between the SC and surgery groups, although the mean operation time of the SC group was significantly shorter than the surgery group (15 [CI, 15-20] vs. 30 [CI, 27-40], P = 0.001), the cost and duration of hospitalization were significantly lower in the surgery group than that in the SC group. No significant differences were observed for adverse events and complications between the two groups (P > 0.05). Hysteroscopy is an effective and economical method for treating type I/II CSP. Moreover, SC is not recommended for patients with type I/II CSP with a gestation age ≥8 weeks.

The effectiveness of single ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation in managing placenta accreta spectrum (PAS) disorder.

To evaluate the feasibility and effectiveness of single ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation in managing placenta accreta spectrum (PAS) disorder. We retrospectively analyzed 40 PAS patients between April 2017 and October 2021. All the patients received one session of HIFU treatment. Regular follow-up was done after HIFU treatment until normal menstruation returned and placental tissue disappeared. The patient's reproductive-related outcomes were obtained through telephone interviews. The median follow-up time for the 40 patients was 30.50 (15.75-44.00) months and the mean placental tissue elimination time was 45.29 ± 33.32days. The mean duration of bloody lochia was 13.43 ± 10.01days, with no incidences of severe bleeding. Notably, Linear regression analysis showed that the residual placenta volume before HIFU was a factor affecting the duration of bloody lochia after HIFU (R2 = 0.284, B = 0.062, P = 0.000). The normal menstrual return time was 58.71 ± 31.14days. One (2.50%) patient developed an infection. Two (5.00%) patients were subjected to ultrasound-guided suction curettage for persistent vaginal discharge for more than one month without infection. Notably, 7 of the 18 patients who expressed reproductive plans became pregnant during the 4 to 53months of follow-up without placental abnormalities. The remaining 11 patients were on contraceptives. Single HIFU is an effective treatment option for managing PAS. However, future studies on further treatment strategies to reduce complications and promote patient recovery after HIFU ablation are desirable.

Analysis of the type of cesarean scar pregnancy impacted on the effectiveness and safety of high intensity focused ultrasound combined with ultrasound-guided suction curettage treatment

Objective To investigate the clinical efficacy and safety of high intensity focused ultrasound (HIFU) combined with ultrasound-guided suction curettage in patients with type I/II/III cesarean scar pregnancy (CSP). Methods A total of 153 patients with CSP were enrolled and classified according to the type of CSP. All of them were treated by HIFU combined with ultrasound-guided suction curettage. When active uterine bleeding was observed after curettage, a Foley balloon was used for hemostasis by compression. Baseline characteristics, technical parameters of HIFU, intraoperative blood loss in suction curettage, the time for serum β-HCG to return to normal levels, reproductive outcomes, and adverse effects were recorded and analyzed. Results 152 patients completed one session of HIFU combined with suction curettage except one patient transferred to surgery. Total energy used for ablation and the time for serum β-HCG return to normal level in type II and III were significantly higher than type I (p < .05). The treatment time and sonication time of HIFU in type III were significantly longer than type I (p < .05). Vaginal bleeding after curettage and the rate of using Foley catheter balloon in type III was larger than type I and II. Conclusions HIFU combined with ultrasound-guided suction curettage is a safe and effective treatment option for patients with type I/II/III CSP and desire for fertility. Patients with type III CSP were more dependent on Foley catheter balloon compression therapy than the other two types after HIFU combined with curettage.

Management of caesarean scar pregnancy with ultrasound guided suction curettage followed by foley balloon catheter placement

ObjectiveCaesarean scar pregnancy (CSP), which is a direct consequence of caesarean delivery, can lead to serious complications such as placenta acreta spectrum (PAS). The aim of this study is to assess the effectiveness of ultrasound-guided suction curettage followed by foley balloon tamponade for the management of CSP in the first trimester of pregnancy. Study designA retrospective evaluation of 32 women who were managed with ultrasound-guided suction curettage and foley balloon catheter insertion to the CSP region was performed. The primary outcome of the study was the rate of successful termination of CSP without need of additional surgical intervention. Secondary outcomes were the rate of haematocrit decrease, duration of hospitalization and need for transfusion. ResultsThe described procedure was performed successfully without need for additional interventions for all patients. Median decrease in the haematocrit level post-operatively was 4% (2.25–5). Median hospitalization time was 1 day (1–2). ConclusionsUltrasound-guided suction curettage followed by foley balloon tamponade is an effective and safe method for the management of CSP. Direct comparative studies with other methods are required for a more precise conclusion.

Evaluation of the necessity of laparoscopic repair of a uterine scar defect for cesarean scar pregnancy.

ObjectiveThis study aimed to determine the risk factors associated with the necessity of laparoscopic scar defect repair for cesarean scar pregnancy (CSP).MethodsWe retrospectively analyzed 237 patients with CSP who were treated by ultrasound-guided suction curettage and/or laparoscopy in our hospital from April 2012 to November 2019. A total of 199 of these patients underwent ultrasound-guided suction curettage without uterine scar defect repair, while 38 of these patients underwent laparoscopic resection and uterine scar defect repair. We analyzed various clinical variables and compared the efficacy of treatment between the two groups.ResultsGestational age, the maximum transverse diameter (MTD) of the gestational sac, myometrial thickness, the operation time, intraoperative blood loss, and the duration of the hospital stay were significantly different between the two groups. Gestational age, the MTD of the gestational sac, and myometrial thickness were independent risk factors for laparoscopic repair.ConclusionsGestational age, the MTD of the gestational sac, and myometrial thickness are important factors associated with the necessity for laparoscopic repair of a uterine scar defect.

The effect of ultrasound-guided suction curettage on reproductive outcomes in patients with cesarean scar pregnancy

Objective: This study aims to evaluate reproductive and pregnancy outcomes in patients with cesarean scar pregnancies (CSP) treated by suction curettage.&#x0D; Methods: This retrospective observational study included 85 patients with CSP treated by suction curettage in a university hospital between 2013-2017. Reproductive status of the patients who could be reached by phone was inquired at 6-month intervals for three years.&#x0D; Results: Hospital records and telephone follow-up data of the 44 patients who completed follow-up were analyzed. Nineteen patients did not desire pregnancy, while 25 patients reported wishing to conceive again. Twenty-three of these patients (92%, 23/25) conceived spontaneously, 2 of them (8%, 2/25) unable to conceive due to unexplained secondary infertility. Mean length of time from CSP to subsequent pregnancy was 12.3 months (range 2-36 months). Of these pregnancies, 11 (47.8%, 11/23) resulted in birth without any obstetrical problems. Six patients (26%, 6/23) experienced miscarriage, and three patients (13%, 3/23) recurrent cesarean scar pregnancies. Two patients (8.6%, 2/23) had abnormal placental invasion and one patient (4.3%, 1/23) tubal ectopic pregnancy. The live birth rate among the pregnancies was 52.1% (12/23).&#x0D; Conclusion: There is no consensus on the primary treatment regarding the reproductive outcomes. Suction curettage is a successful, reliable, inexpensive and easily applicable treatment when appropriate patients are selected. Furthermore, it has a minimal negative effect on fertility, so it can be considered as a first-line treatment option in patients who wish to have children in the future.

Suction Curettage and Foley Balloon as a First-Line Treatment Option for Caesarean Scar Pregnancy and Reproductive Outcomes.

BackgroundCaesarean scar pregnancy (CSP) is associated with various serious pregnancy complications. This study presents the outcomes of patients treated with suction curettage and Foley balloon as the first-line treatment for CSP as well as their future outcomes in terms of successful pregnancy.MethodsOf the 44 patients diagnosed with CSP between January 2015 and April 2019, 42 who provided consent for the termination of pregnancy and who simultaneously underwent the transabdominal ultrasound-guided suction curettage + Foley balloon treatment were included in the study. These patients were then contacted and interviewed to collect data concerning their post-treatment number of pregnancies, number of miscarriages, number of live or dead births, mode of delivery, delivery time as well as whether any abnormal placental invasion or uterine ruptures developed.ResultsTransabdominal ultrasound-guided suction curettage + Foley balloon was simultaneously performed as the first-line treatment in 42 patients with CSP. In two of these cases, wherein post-treatment level of β-hCG reached a plateau, single-dose systemic methotrexate was administered. Emergency surgical intervention, hysterectomy, massive blood transfusion and additional systemic methotrexate administration were not required. Twenty-six of 42 patients could be contacted. 18/26 were trying to conceive. 6/18 patients had secondary infertility, and 12/18 patients managed to conceive. 8/12 had caesarean delivery at full term. 1/12 was 16-week pregnant, 1/12 had tubal ectopic pregnancy and 2/12 had first-trimester abortus.ConclusionWhen administered as the first-line treatment for CSP, the suction curettage + Foley balloon treatment is a highly successful, cheap and easily performed minimally invasive method that requires only a short hospital stay, making it comfortable for patients. Compared with other uterine-sparing methods, it does not harm fertility and has positive effects on patients’ future fertility outcomes.

Focused Ultrasound Ablation Surgery combined with ultrasound-guided suction curettage in the treatment and management of Cesarean Scar Pregnancy

ObjectiveTo evaluate the feasibility, safety, and effectiveness of Focused Ultrasound Ablation Surgery (FUAS) combined with ultrasound-guided suction curettage in the management of Cesarean Scar Pregnancy (CSP). Study designWe retrospectively analyzed 52 patients with CSP from April, 2017, to December, 2019. All the patients received one session of FUAS, and suction curettage under ultrasound guidance was performed 1–3 days after FUAS. The intraoperative blood loss in suction curettage, duration of vaginal bleeding after curettage, reproductive outcomes, and adverse effects were recorded and analyzed. ResultsAll the 52 patients completed one session of FUAS combined with suction curettage without serious adverse effects. The mean intraoperative blood loss was 32.81 ± 53.83 mL. 47 (90.38 %) patients had a successful suction curettage with a blood loss of less than 80 mL. 5 (9.62 %) patients had an active bleeding of ≥80 mL; however, the bleeding was stopped effectively by Foley's urinary catheter and no evident bleeding presented when the catheter was removed 24 h later. The mean duration of vaginal bleeding was 7.88 ± 4.24 days. 48 (92.30 %) patients recovered with little vaginal bleeding after curettage. 4 (7.69 %) type III CSP patients experienced late-onset severe bleeding and required UAE or surgery. During 6–36 months of the follow-up period, 12 patients expressed reproductive plan, in which 4 patients delivered by cesarean section, 3 patients had an ongoing pregnancy and 1 patient had an abortion in the early pregnancy. ConclusionsFUAS combined with ultrasound-guided suction curettage is a safe and effective treatment strategy in the management of CSP type I and CSP type II and is particularly advantageous for CSP patients with reproductive requirements. However, further studies are warranted to determine the meticulous inclusion criteria for patients with type III CSP.

Lower uterine segment thickness in assessing whether cesarean scar pregnancy patients could be treated with suction curettage

Background: To find a suitable indicator in selecting appropriate patients with cesarean scar pregnancy (CSP) for treatment with ultrasound-guided suction curettage alone.Methods: A retrospective review of all women with CSP treated at the Tongji Hospital, Wuhan, China, between 1 January 2013 and 31 December 2015 was conducted. The women were grouped according to the following management options: ultrasound-guided suction curettage only (Group 1); combination with other therapeutic options (Group 2). The clinical characteristics and outcomes were analyzed.Results: Of 174 patients with lower uterine segment myometrium thickness ≥0.2 cm, 93 (53.4%) patients underwent ultrasound-guided suction curettage only, 81 (46.6%) patients underwent a combination with other therapeutics. Clinical characteristics of women who underwent ultrasound-guided suction curettage alone did not significantly differ from those who were treated with combination. Intraoperative blood loss and length of stay differed significantly between the two groups.Conclusions: In appropriate CSP cases with lower uterine segment myometrium thickness more than 0.2 cm, ultrasound-guided suction curettage appears to be a reliable treatment option producing satisfying success rates, lower blood loss, and a shorter hospital-stay compared to combined therapies.

The impact of gestational sac size on the effectiveness and safety of high intensity focused ultrasound combined with ultrasound-guided suction curettage treatment for caesarean scar pregnancy

Objective: To evaluate the correlation between the gestational sac size and the effect and safety of high intensity focused ultrasound (HIFU) combined with ultrasound-guided suction curettage for caesarean scar pregnancy (CSP).Methods: Seventy-six patients with CSP were enrolled. Based on their gestational sac size, patients were divided into three groups: Group 1 (n = 16, 10–20 mm), Group 2 (n = 28, 21–30 mm) and Group 3 (n = 32, >30 mm). All of them were treated by HIFU combined with ultrasound-guided suction curettage. Baseline characteristics, parameters and adverse events of HIFU, and intraoperative hemorrhage during ultrasound-guided suction curettage were recorded.Results: The median treatment time and average treatment intensity of HIFU in Group 3 were significantly higher than Group 1 (p < .05); the median HIFU treatment power in Group 2 and Group 3 were both significantly higher than that of Group 1 (p < .05). The median sonication time of HIFU in Group 3 was significantly longer than patients in the other two groups (p < .05). The size of the gestational sac had a positive correlation with all the above-mentioned parameters of HIFU and blood loss during ultrasound-guided suction curettage (p < .05). No statistically significant differences were observed among the three groups in the duration of vaginal bleeding post-curettage and the time necessary for serum β-hCG to return to normal levels (p > .05).Conclusions: HIFU combined with ultrasound-guided suction curettage is a safe and effective clinical approach for CSP. Gestational sac size is a meaningful factor for predicting the efficacy and safety of HIFU treatment and hemorrhage during ultrasound-guided suction curettage.

Management of Caesarean scar pregnancy with or without methotrexate before curettage: human chorionic gonadotropin trends and patient outcomes

BackgroundTo evaluate the effects of systemic methotrexate in cesarean scar pregnancy (CSP) patients treated with ultrasound-guided suction curettage.MethodsA retrospective review of all women presenting with CSP treated with ultrasound-guided suction curettage at Tongji Hospital, Wuhan, China, between January 1, 2013 and December 31, 2015, was conducted. Patients were grouped into those not treated with methotrexate before curettage (group 1), treated with methotrexate by intramuscular injection (group 2) and treated with methotrexate by intravenous injection (group 3). The clinical characteristics and outcomes were analyzed.ResultsAmong 107 patients, 47 patients were not treated with methotrexate before curettage, 46 patients had methotrexate administered by intramuscular injection and 14 patients had methotrexate injected intravenously. There were no significant differences among the groups in basic and clinical characteristics, such as age, gravity, parity, positive fetal heart beat and gestational age at diagnosis. Patients presented similar initial human chorionic gonadotropin (hCG) levels in all groups. After treatment with methotrexate or curettage, the percentage changes and varied ranges of the hCG levels were also similar in all groups. There were no significant differences in intraoperative blood loss and retained products of conception among the three groups. However group 1 had significantly shorter hospital stays than the two groups that were treated with methotrexate (p<0.001).ConclusionBy grouping CSP patients who shared similar age, gravity, parity, fetal heart beat positive and gestational age at diagnosis, we found that the presence or absence of methotrexate treatment before curettage resulted in comparable outcomes and hCG levels, although patients who were not treated with methotrexate had significantly shorter stays in the hospital.

Is ultrasound-guided suction curettage a reliable option for treatment of cesarean scar pregnancy? A cross-sectional retrospective study

Purpose: The purpose of our study is to present clinical courses and outcomes of 50 first-trimester cesarean scar pregnancy (CSP) cases, which are managed either with transabdominal ultrasound (TAUS)-guided suction curettage alone or abdominal hysterotomy. Methods: We retrospectively analyzed our records from 2011 to 2016 at a single-center. TAUS-guided suction curettage alone was preferred in hemodynamically stable patients when the myometrial thickness was ≥3 mm and there was no vascular invasion. If the myometrial thickness was <3 mm and/or vascular invasion was present, then hysterotomy was preferred. Results: Statistical analysis of age, gravidity, parity, history of previous CS (≥3 or <3), presence of embryonic cardiac activity, complaints (vaginal bleeding, pelvic pain, or both), preoperative and postoperative hemoglobin levels (g/dl), blood transfusion, initial serum β-hCG levels, and duration to resolution of β-hCG demonstrated no significant difference between TAUS-guided suction curettage and abdominal hysterotomy groups. There was a significant difference between two groups in terms of postoperative length of stay in the hospital and gestational age. Conclusion: TAUS-guided suction curettage in selected cases may be considered as a reliable first-line treatment option due to its low cost, ease of application, lower side-effect profile, and potentially minimal influence on future fertility in CSP patients that are hemodynamically stable.

Cook Cervical Ripening Balloon successfully prevents excessive hemorrhage combined with ultrasound-guided suction curettage in the treatment of cesarean scar pregnancy.

Cesarean scar pregnancy (CSP) is a rare occurrence of ectopic pregnancy. CSP incidence has increased significantly as a result of the increase in cesarean section rates. At present, there are no standard treatment guidelines for CSP; therefore, we report a minimally invasive treatment method for patients diagnosed with CSP. This study included 15 women who were diagnosed with CSP. Ultrasound-guided suction curettage was performed on all patients. The Cook Cervical Ripening Balloon was used to tamponade and prevent hemorrhage during the procedure. In 12 patients, the balloon was placed immediately following ultrasound-guided suction curettage; in two patients, the balloon was placed when excessive bleeding occurred post-curettage; and in one patient, the balloon was placed after the gestational sac evacuated by itself, and then suction aspiration was performed on day 5, following the evacuation. Human chorionic gonadotropin levels were evaluated three days after the procedure. Placement and inflation of the Cook Cervical Ripening Balloon was well tolerated by all patients. The balloon tamponade effectively reduced or prevented vaginal bleeding in all patients, and none of the patients had an estimated blood loss higher than 1000 ml. Ultrasound-guided suction curettage is effective in the treatment of CSP. The Cook Cervical Ripening Balloon is easy to place and inflate and successfully prevented bleeding or assisted in the management of bleeding complications. We recommend the Cook Cervical Ripening Balloon as an adjuvant method for ultrasound-guided suction curettage for the treatment of CSP.

Successful Live Birth after Medical and Surgical Treatment of Cesarean Scar Pregnancy: A Case Report

Cesarean Scar Pregnancy (CSP) is a rare type of ectopic pregnancy needing a high index of suspicion to make an early diagnosis. Recent literature describes treatment of CSP using methotrexate (MTX). Surgical options include hysteroscopic coagulation of vessels at implantation site, laparoscopic removal of gestational sac, laparotomy with wedge resection of pregnancy; ultrasound guided suction curettage and uterine artery embolization with injection of MTX locally. However, to date no universal guidelines exist regarding its management. A case of successful management of a pregnancy in a previous Cesarean section scar, with the use of systemic methotrexate followed by ultrasound guided evacuation of the uterus is presented, followed by an uncomplicated live birth in the successive pregnancy.

Successful treatment of endogenous cesarean scar pregnancies with transabdominal ultrasound-guided suction curettage alone

ObjectiveTo investigate the efficacy and safety of transabdominal ultrasound-guided suction curettage alone in endogenous cesarean scar pregnancy (CSP). Study designFrom 2009 to 2013, 21 women with endogenous CSP who had no other therapy underwent suction curettage alone guided with transabdominal ultrasound. ResultsAll patients were successfully treated with suction curettage alone. No one needed emergency blood transfusion or uterine artery embolization. The average gestational age was 51.1±7.56 days. The mean thickness of the lower anterior uterine wall was 0.5cm, ranging from 0.3cm to 0.9cm. The average blood loss during surgery was 81.3±33.5 (30–150)ml. The mean time for achieving a normal β-HCG level was 26.9 days. ConclusionTransadominal ultrasound-guided suction curettage was a feasible and effective method for lower risk endogenous CSP patients with the myometrial layer between the gestational sac and the bladder more than 3mm before 10 gestational weeks.