Optimal Treatment Selection for Cesarean Scar Pregnancy: Using a Predictive Score of Intraoperative Blood Loss: A...

The significant risk associated with treatment for cesarean scar pregnancy (CSP) is the potential for severe hemorrhage at termination, resulting in controversy over optimal treatment and no international standards. Our previous study proposed that estimating intraoperative blood loss from ultrasound findings, called quantitative risk-scoring (QRS), may help select the optimal treatment. In this study, we analyzed the success rate in selecting the optimal treatment for CSP based on QRS.

A total of 318 CSP cases were included, and the initial treatment, including suction evacuation or uterine artery embolisation (UAE), was selected based on intraoperative blood loss estimates. Failure and intraoperative blood loss were measured.

The mean intraoperative blood loss in CSP cases with QRS < 3 who underwent suction evacuation were not statistically different from CSP cases with UAE. In CSP cases with QRS ≥ 3, there were 14 (10%) or 6 (8%) unsuccessful cases with suction evacuation or UAE. The mean intraoperative blood loss after excluding failure was not statistically different between the two groups. Additionally, type 2 CSP cases with QRS ≥ 3 and UAE had lower intraoperative blood loss than those who initially underwent hysteroscopy or laparoscopy, with 5 (8%) cases being unsuccessful. Our study suggested that suction evacuation is safe, with a higher success rate and minimal blood loss for cases with QRS < 3. Similarly, the UAE is safe with minimal blood loss for CSP cases with QRS ≥ 3, although the unsuccessful rate was slightly higher.

Our study suggests that QRS can be a tool for selecting initial treatment for CSP in clinical practice.