title: Surgical treatment of Cesarean scar ectopic pregnancy: efficacy and safety of ultrasound-guided suction curettage.
abstract: OBJECTIVE
  To assess the efficacy of ultrasound-guided suction curettage for management of pregnancies implanted into the lower uterine segment Cesarean section scar.
  
  
  METHODS
  This was a retrospective study including women diagnosed with Cesarean section scar pregnancy at two large tertiary referral early pregnancy units between 1997 and 2014. Surgical evacuation was offered to selected women presenting in the first trimester ≤ 14 weeks' gestation. All procedures were performed transcervically under ultrasound guidance using suction curettage. A modified Shirodkar cervical suture was used in women who required additional measures to secure hemostasis.
  
  
  RESULTS
  A total of 232 women with Cesarean section scar pregnancy were seen at the referral units; 191/232 (82.3%) women were treated surgically. The median intraoperative blood loss was 100 mL (range, 10-3000 mL); 9/191 (4.7% (95% CI, 1.7-7.7%)) women required blood transfusion and, in one (0.5% (95% CI, 0-1.5%)), life-saving hysterectomy had to be performed because of uncontrollable intraoperative bleeding. Of the women who attended for follow-up, 7/116 (6.0% (95% CI, 1.7-10.3%)) required a repeat surgical procedure because of retained products of conception. Multivariable analysis showed that the gestational sac diameter (odds ratio (OR), 1.10 (95% CI, 1.03-1.17)) and pregnancy vascularity on Doppler examination (OR, 3.41 (95% CI, 1.39-8.33)) were significant predictors of heavy intraoperative blood loss (> 1000 mL).
  
  
  CONCLUSIONS
  Ultrasound-guided suction curettage is an effective method for the treatment of pregnancies implanted into a lower uterine segment Cesarean section scar and is associated with a low risk of blood transfusion and hysterectomy. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
authors.affiliation: Institute of Women's Health, University College Hospital, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Jurkovic
authors.affiliation: Institute of Women's Health, University College Hospital, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Knez
authors.affiliation: Early Pregnancy Unit, King's College Hospital, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Appiah
authors.affiliation: Early Pregnancy Unit, King's College Hospital, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Farahani
authors.affiliation: Institute of Women's Health, University College Hospital, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Mavrelos
authors.affiliation: Early Pregnancy Unit, King's College Hospital, London, UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Ross
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects; D002921:Cicatrix / Q000150:complications*; D005260:Female; D005865:Gestational Age; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional / Q000009:adverse effects* / Q000379:methods; D016216:Ultrasonography, Prenatal / Q000379:methods*; D014619:Vacuum Curettage / Q000009:adverse effects* / Q000379:methods
keywords: Cesarean scar pregnancy; reproductive outcomes; suction curettage; surgical management; ultrasound