The Success of Surgical and Medical Approach in the Treatment of Cesarean Scar Pregnancy

IF 0.8 Q4 REPRODUCTIVE BIOLOGY
S. Masihi, M. Najafian, M. Barati, Zohreh Mirfazli
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引用次数: 0

Abstract

Objectives: The ectopic pregnancy in the cesarean section (CS) scar (CSP) is one of the potentially dangerous and late complications of CS. The current study aimed to evaluate the therapeutic approaches in managing CS scar ectopic pregnancy. Materials and Methods: This cross-sectional study was carried out on 63 CSP patients. The treatment approach was considered based on the shape and nature of the gestational sac (GS) during ultrasound evolutions. Patients’ demographic data, clinical manifestations, and systemic drug treatment (methotrexate, MTX), as well as the type of surgery, hospitalization times, and treatment-related complications were evaluated, followed by comparing the treatment efficacy in different approaches based on the human chorionic gonadotropin (hCG) resolution time. Results: The mean age of the subjects was 34.2±5.1 years (within the range of 22-44 years) and the median of B-hCG serum levels at diagnosis was 2319 IU. The vaginal bleeding and abdominal pain (27 [42.9%]) were the most common complaints, followed by a delayed menstrual cycle (8 [12.7%]). The majority of patients were subjected to surgical treatment and 29 cases (46%) were treated by medical approaches. The median time to B-hCG resolution was 42 days. The Cox proportional hazards model showed the significant effect of the treatment approach on time to B-hCG resolution (χ2 =37.78, df=4, P<0.0001). Finally, the MTX plus surgery was the most effective treatment approach (OR=10.56, P<0.0001) in managing CSP patients. Conclusions: Our findings in line with previous studies showed the superiority of the surgical approach alone or in combination with medical treatments compared to medical approaches alone.
剖宫产瘢痕妊娠的外科与内科治疗的成功
目的:剖宫产术后瘢痕(CSP)异位妊娠是剖宫产的潜在危险和晚期并发症之一。本研究旨在探讨CS瘢痕异位妊娠的治疗方法。材料与方法:对63例CSP患者进行横断面研究。治疗方法是根据超声演变过程中妊娠囊(GS)的形状和性质考虑的。评估患者的人口学资料、临床表现、全身药物治疗(甲氨蝶呤、MTX)、手术类型、住院时间、治疗相关并发症,并根据人绒毛膜促性腺激素(hCG)消退时间比较不同方法的治疗效果。结果:患者平均年龄为34.2±5.1岁(22 ~ 44岁),诊断时血清B-hCG水平中位数为2319 IU。阴道出血和腹痛是最常见的主诉(27例[42.9%]),其次是月经周期延迟(8例[12.7%])。大多数患者接受手术治疗,29例(46%)患者接受内科治疗。B-hCG缓解的中位时间为42天。Cox比例风险模型显示,治疗方式对B-hCG解决时间有显著影响(χ2 =37.78, df=4, P<0.0001)。最后,MTX加手术是治疗CSP患者最有效的治疗方法(OR=10.56, P<0.0001)。结论:我们的研究结果与以往的研究一致,表明单纯手术入路或联合药物治疗优于单纯药物入路。
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来源期刊
CiteScore
1.60
自引率
14.30%
发文量
8
期刊介绍: All kind of knowledge contributing to the development of science by its content, value, level and originality will be covered by IJWHR. Problems of public health and their solutions are at the head of the windows opening us to the world. The "International Journal of Women''s Health and Reproduction Sciences” is a modern forum for scientific communication, covering all aspects women health and reproduction sciences, in basic and clinical sciences, mainly including: -Medical Education in Women Health and Reproduction Sciences -Cardiology in Women Health-Related Reproductive Problems -Sports Medicine in Women Health and Reproduction Sciences -Psychiatry in Women Health-Related Reproductive Problems -Antioxidant Therapy in Reproduction Medicine Sciences -Nutrition in Women Health and Reproduction Sciences -Defense Androgen and Estrogen -Fertility and Infertility -Urogynecology -Endometriosis -Endocrinology -Breast Cancer -Menopause -Puberty -Eroticism -Pregnancy -Preterm Birth -Vaginal Diseases -Sex-Based Biology -Surgical Procedures -Nursing in Pregnancy -Obstetrics/Gynecology -Polycystic Ovary Syndrome -Hyperandrogenism in Females -Menstrual Syndrome and Complications -Oncology of Female Reproductive Organs -Traditional Medicine in Women Reproductive Health -Ultrasound in Women Health Reproduction sciences -Stem Cell Research In Women Reproduction Sciences -Complementary Medicine in Women Reproductive Health -Female Sexual Dysfunction: Pathophysiology & Treatment
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