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Comparative Efficacy of Different Therapeutic Modalities in the Management of Cesarean Scar Pregnancy Based on
Haiying Sun1, Juan Wang2, Ting Zhou1
1Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (Sun, Zhou and Liu), Wuhan, PR China; Key Laboratory of Cancer Invasion and Metastasis (Ministry of Education), Hubei Key Laboratory of Tumor Invasion and Metastasis, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (Sun, Zhou and Liu), Wuhan, PR China.
Objective:
This study seeks to investigate tailored treatment approaches and conduct a comprehensive analysis of the effectiveness of various treatment strategies for different subtypes of CSP. The primary objective is to compare the clinical outcomes associated with each subtype across the 2 existing classification methods and the novel classification method we propose, thereby identifying the most appropriate CSP classification method for developing personalized treatment strategies.
Design:
A retrospective study.
Setting:
A tertiary medical center.
Participants:
A cohort of 1248 patients diagnosed with CSP.
Interventions:
The treatment approaches and clinical outcomes of each subtype were examined using different classification methods.
Measurements And Main Results:
The study examined the treatment approaches and clinical outcomes of each subtype using 3 classification methods and analyzed the rationale for employing multiple treatment options. Additionally, a comparative analysis of 3 vascular pretreatment methods was conducted to assess their necessity. The results revealed a success rate of 95.5% across different treatment protocols. Statistical analysis revealed significant differences in the management of different CSP subtypes according to their classification system (p <.001). Compared to the other 2 CSP classifications, the Liu classification enables doctors to adopt more appropriate treatment strategies based on the specific subtypes. Furthermore, there were notable variations in the vascular pretreatment methods employed across the 5 patient subgroups (p <.001). UAE was predominantly utilized for patients undergoing suction curettage (SC) and hysteroscopy, whereas permanent vascular ligation or temporary vascular occlusion were the primary methods for patients undergoing laparoscopic surgery.
Conclusions:
In comparison to the 2 existing CSP classification methods, the treatment strategies derived from our newly proposed CSP classification demonstrate greater appropriateness. For type ⅠCSP, ultrasound-guided SC is the standard surgical intervention. Type Ⅱa CSP is frequently addressed through hysteroscopic procedures, whereas type Ⅱb and Ⅲ CSP often necessitates laparoscopic intervention.
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