Risk factors for intraoperative hemorrhage at evacuation of a cesarean scar pregnancy following uterine artery embolization.
OBJECTIVE
To determine risk factors associated with massive uterine bleeding during dilation and suction curettage (D&C) after uterine artery embolization (UAE) for the treatment of cesarean scar pregnancy (CSP).


METHODS
Data from 128 CSP patients treated with D&C after UAE were analyzed to assess risk factors associated with massive uterine bleeding (blood loss 500mL or more) during D&C after UAE.


RESULTS
In total, 15 CSP patients had massive bleeding during D&C after UAE. Univariate analysis showed that a greater gestational age (GA), a larger CSP mass size, a thinner myometrium at the implantation site, a GA of 8weeks or more, a CSP mass diameter of 6cm or more, and evidence of fetal heartbeat were risk factors for massive bleeding (P<0.05). In a binary logistic regression analysis, GA of 8weeks or more and CSP mass diameter of 6cm or more remained as the only significant risk factors for massive bleeding (OR 11.49 [95% CI 1.08-122.13] and OR 96.59 [95% CI 6.20-150.57], respectively; P<0.05).


CONCLUSIONS
For CSP masses with a GA of 8weeks or more and a diameter of 6cm or more, the outcome of surgical evacuation after UAE tends to be unsatisfactory.
Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Jian-Hua
JH
Wang
Zhi-Da
ZD
Qian
Ya-Ling
YL
Zhuang
Yong-Jiang
YJ
Du
Lin-Hua
LH
Zhu
Li-Li
LL
Huang
D000328:Adult; D016063:Blood Loss, Surgical; D002585:Cesarean Section / Q000009:adverse effects; D002921:Cicatrix / Q000209:etiology / Q000473:pathology; D003131:Combined Modality Therapy; D004107:Dilatation and Curettage / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009215:Myometrium / Q000473:pathology; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000628:therapy*; D012307:Risk Factors; D055357:Uterine Artery Embolization / Q000379:methods*; D014592:Uterine Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult
Cesarean scar pregnancy; Curettage; Methotrexate; Uterine artery embolization