title: Outcomes of primary surgical evacuation during the first trimester in different types of implantation in women with cesarean scar pregnancy.
abstract: OBJECTIVE
  To assess the efficacy and safety of primary surgical evacuation therapy for cesarean scar pregnancy (CSP) of the first trimester, and to evaluate its possible prognostic factors.
  
  
  METHODS
  Retrospective consecutive cohort study.
  
  
  METHODS
  Tertiary care university hospital.
  
  
  METHODS
  A cohort of patients with CSP and clear ultrasound images who underwent primary surgical evacuation from January 2000 to December 2012.
  
  
  METHODS
  Patients fulfilling the ultrasound criteria of CSP were further classified into superficial and deep groups according to their implantation locations and extents. The final decision on the method of treatment, including methotrexate chemotherapy, surgical evacuation, and others, was made by the patients after consultation with the physician. Pretreatment patient characteristics were compared in the patients with superficial and deep implantation, as were the results after primary surgical evacuation.
  
  
  METHODS
  Rates of successful treatment by primary surgical evacuation of CSP and the need for salvage intervention in the patients with deep and superficial implantation.
  
  
  RESULTS
  Forty-eight CSP patients who had sufficient data and imaging for analysis were enrolled. Of these 48 cases, 26 in the superficial group and 14 in the deep group were willing to undergo primary surgical evacuation. Blood loss and need for salvage intervention were significantly lower in the patients with superficial implantation. Surgical evacuation was successful in 23 of 26 patients (88.5%) with superficial implantation and in 8 of 14 patients (57.1%) with deep implantation. Patients who failed primary surgical evacuation showed complete recovery, with uterus preservation, after salvage interventions, including laparoscopic surgery, angioembolization, and laparotomy.
  
  
  CONCLUSIONS
  Preoperative determination of CSP implantation depth and extent is important in selecting candidates for surgical treatment. Primary single-step surgical evacuation was successful in most patients with superficial implantation, but patients should be informed of the possibility of salvage interventions before undergoing surgical evacuation.
authors.affiliation: Department of Obstetrics and Gynecology, Chiayi Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Chiayi, Taiwan.
authors.forename: Ling-Yun
authors.initials: LY
authors.lastname: Cheng
authors.affiliation: Department of Obstetrics and Gynecology, Chiayi Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Chiayi, Taiwan.
authors.forename: Chen-Bin
authors.initials: CB
authors.lastname: Wang
authors.affiliation: Department of Obstetrics and Gynecology, Chiayi Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Chiayi, Taiwan.
authors.forename: Li-Ching
authors.initials: LC
authors.lastname: Chu
authors.affiliation: Department of Obstetrics and Gynecology, Chiayi Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Chiayi, Taiwan.
authors.forename: Chih-Wen
authors.initials: CW
authors.lastname: Tseng
authors.affiliation: Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. Electronic address: ftkung@cloud.cgmh.org.tw.
authors.forename: Fu-Tsai
authors.initials: FT
authors.lastname: Kung
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D016216:Ultrasonography, Prenatal; D014619:Vacuum Curettage / Q000009:adverse effects
keywords: Cesarean scar pregnancy; implantation type; primary evacuation therapy