title: Management of Cesarean Scar Pregnancy Using Ultrasound-Guided Dilation and Curettage.
abstract: To evaluate the potential risk factors associated with failed ultrasound-guided dilation and curettage (D&C) treatment of cesarean scar pregnancy (CSP).
  
  
  
  Retrospective study.
  
  
  
  University hospital.
  
  
  
  Fifty-one patients diagnosed with CSP and treated with ultrasound-guided D&C at Shanghai General Hospital of Shanghai Jiao Tong University.
  
  
  
  Lesion resection using ultrasound-guided D&C.
  
  
  
  Clinical characteristics, vaginal bleeding, abdominal pain, the size of the gestational sac, cardiac motion, blood flow around the gestational sac, cesarean scar thickness, and serum β-human chorionic gonadotropin (β-hCG) levels were compared between the successful operation group and the failed operation group. Cesarean scar thickness was the main risk factor that determined the success of ultrasound-guided D&C. The success rates were 50% and 97.67% for those with cesarean scars <3 mm thick and those with scars >3 mm thick, respectively (p = .001). The success rate was also associated with the abundance of blood flow surrounding the capsule and size of the gestational sac (p < .005). Surgical success was not affected by abnormal vaginal bleeding, abdominal pain, cardiac motion, or serum β-hCG levels.
  
  
  
  Ultrasound-guided D&C is the first choice for treating CSP if the cesarean scar is >3 mm thick, blood flow is not abundant, and the maximum diameter of the gestational sac is <30 mm. A transabdominal procedure is preferred for patients with high-risk factors.
authors.affiliation: Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Suqing
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Sun
authors.affiliation: Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Cai
authors.affiliation: Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Xiaowei
authors.initials: X
authors.lastname: Xi
authors.affiliation: Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Liu
authors.initials: L
authors.lastname: Yang
authors.affiliation: Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: sunyy2003@126.com.
authors.forename: Yunyan
authors.initials: Y
authors.lastname: Sun
mesh_terms: D015746:Abdominal Pain; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects; D002681:China; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D002921:Cicatrix / Q000209:etiology / Q000601:surgery*; D004107:Dilatation and Curettage / Q000379:methods*; D005260:Female; D058746:Gestational Sac; D006801:Humans; D009929:Organ Size; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000097:blood / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D025321:Surgery, Computer-Assisted / Q000379:methods*; D017211:Treatment Failure; D014463:Ultrasonography; D014592:Uterine Hemorrhage; D055815:Young Adult
chemical_list: D018997:Chorionic Gonadotropin, beta Subunit, Human
keywords: Cesarean scar pregnancy; Cesarean scar thickness; Risk factors; Ultrasound-guided dilation and curettage