[Cross-sectional investigation and analysis of the early warning threshold for intraoperative bleeding intervention during dilation and curettage in type Ⅱ cesarean scar pregnancy].

Abstract

Objective: To investigate nationwidely the alert threshold for intraoperative bleeding intervention during dilation and curettage (D&C) for type Ⅱ cesarean scar pregnancy (CSP) in the first trimester. Methods: A retrospective cross-sectional survey was conducted. From March 11 to April 14, 2022, obstetricians and gynecologists affiliated with professional associations or institutions of Family Planning Subgroup, Chinese Society of Obstetrics and Gynecology, Chinese Medical Associaton were surveyed using "Expert Consultation Questionnaire on Alert Threshold for Intraoperative Blood Loss in CSP". The questionnaire was distributed via WeChat using the Questionnaire Star platform. Observation indicators included professional expertise of participants, preferred treatment modalities for type Ⅱ CSP, and an alert threshold for intraoperative bleeding during D&C. Results: A total of 361 valid questionnaires were collected. Among 361 participants, 73.7% (266/361) held the title of associate chief physician or higher, 61.2% (221/361) had ≥20 years of clinical experience, and 71.8% (178/248) worked in tertiary general hospitals. The most common treatment for type Ⅱ CSP was D&C following pretreatment with medication, uterine artery embolization (UAE), or high intensity focused ultrasound (HIFU), the percentage was 35.73% (129/361). 51.2% (185/361) of participants recommended an alert threshold of 100 ml for intraoperative bleeding during D&C. Cross-analysis revealed that participants managing <30 cases annually preferred ultrasound-guided D&C (32.0%, 56/175), those managing 30-99 cases or 100-199 cases per year favored pretreatment with medication, UAE or HIFU+D&C (39.0%, 55/141; 52.9%, 18/34), those managing ≥200 cases per year preferred hysteroscopic D&C (4/11). The most frequently selected alert threshold was 100 ml. In the subgroup analysis of participants with ≥100 cases annual admissions for CSP, 46.7% (21/45) of participants chose medication, UAE or HIFU pretreatment+D&C, while 53.3% (24/45) supported setting the alert threshold at 100 ml. Conclusions: The preferred treatment for type Ⅱ CSP is D&C following medication, UAE or HIFU pretreatment, with an intraoperative bleeding alert threshold of 100 ml. Timely alerts and proactive interventions could reduce injury severity, improve outcomes, and optimize CSP management strategies.