[Clinical evaluation of practical clinical classification system for cesarean scar pregnancy]

Objective: To evaluate the clinical application value of practical clinical classification system for cesarean scar pregnancy (CSP). Methods: A total of 1 076 patients with CSP admitted to Peking University Third Hospital from January 2014 to December 2023 were retrospectively included in the study. According to the practical clinical classification system for CSP, the patients were divided into 5 groups (type Ⅰ, Ⅱa, Ⅱb, Ⅲa and Ⅲb). The clinical characteristics, diagnosis and treatment variance of different types of CSP patients were analyzed, and the treatment strategy recommended by this study was compared with that recommended by the practical clinical classification system. Results: The prevalence of type Ⅰ, Ⅱa, Ⅱb, Ⅲa and Ⅲb were 37.1% (399/1 076), 42.0% (452/1 076), 8.5% (91/1 076), 10.5% (113/1 076) and 2.0% (21/1 076), respectively. The median gestational age at diagnosis was 47 days, the median length of hospital stay was 2 days, the median hospitalization cost was 5 816 yuan, the median operation time was 36 minutes, the median intraoperative blood loss was 23 ml, and 5.6% (60/1 076) patients had intraoperative blood loss≥300 ml; 2.6% (28/1 076) patients received blood transfusion, 94.9% (1 021/1 076) patients underwent minimally invasive surgery. There were significant differences in the above indicators between the 5 groups (all P<0.05). The treatments of 86.0% (925/1 076) patients were consistent with the recommendations of the practical clinical classification system. There were 7.7% (83/1 076) patients had more minimally invasive treatment compared with the recommendations, all of which were type Ⅲ patients. There were 6.3% (68/1 076) patients had more invasive treatment compared with the recommendations, mainly were type Ⅱa, Ⅱb and Ⅲa patients. The first-line treatment was successful in 96.4% (1 037/1 076) patients. Conclusions: Practical clinical classification system for CSP has good discrimination and clinical applicability, and provides the principle of minimally invasive surgery. For the management of type Ⅲ patients, individualized evaluation should be carried out on the basis of flexible application of the practical clinical classification system, combined with the diagnosis and treatment conditions of medical institutions and the patient's condition.