title: Factors associated with successful transabdominal sonography-guided dilation and curettage for early cesarean scar pregnancy.
abstract: OBJECTIVE
  To investigate factors associated with successful transabdominal sonography-guided dilation and curettage for the treatment of cesarean scar pregnancy (CSP).
  
  
  METHODS
  In a retrospective study, data were reviewed from patients who received transabdominal sonography-guided dilation and curettage (TASDC) as the primary treatment for early CSP at The Second Xiangya Hospital, Changsha, China, between 2009 and 2013.
  
  
  RESULTS
  Among 232 patients, 185 (79.7%) women with CSP were successfully treated with TASDC. Among them, 81 (43.8%) required insertion of a Foley catheter into the lower uterine segment to stop bleeding. The complication rate was 37.9% (88/232) and the failure rate was 21.3% (47/232). Overall, 28 (12.1%), 5 (2.2%), and 4 (1.7%) patients with massive intraoperative uterine bleeding were treated with wedge resection of the uterus, hysterectomy, and uterine artery embolization as a secondary treatment, respectively. In binary logistic regression analysis, pregnancy of 7 weeks or less and pregnancy without missed abortion were associated with successful TASDC for patients with CSP (P<0.001).
  
  
  CONCLUSIONS
  Pregnancy of 7 weeks or less and pregnancy without missed abortion were found to be important factors for successful TASDC among patients with CSP. Wedge resection was the main secondary treatment to preserve the uterus and remove gestational tissue among patients with massive bleeding.
authors.affiliation: Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Xian-Qing
authors.initials: XQ
authors.lastname: Wu
authors.affiliation: Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Hong-Wen
authors.initials: HW
authors.lastname: Zhang
authors.affiliation: Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Xiao-Ling
authors.initials: XL
authors.lastname: Fang
authors.affiliation: Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Ding
authors.affiliation: Department of Obstetrics and Gynecology, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, OH, USA.
authors.forename: Longzhu
authors.initials: L
authors.lastname: Piao
authors.affiliation: Department of Obstetrics and Gynecology, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, OH, USA. Electronic address: joseph.huang@osumc.edu.
authors.forename: S
authors.initials: S
authors.lastname: Joseph Huang
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002681:China; D002921:Cicatrix / Q000209:etiology / Q000473:pathology*; D004107:Dilatation and Curettage / Q000379:methods*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D016015:Logistic Models; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional / Q000379:methods; D055357:Uterine Artery Embolization / Q000379:methods; D014592:Uterine Hemorrhage / Q000453:epidemiology / Q000628:therapy
keywords: Cesarean scar pregnancy; Transabdominal sonography-guided dilation and curettage