title: Exogenous cesarean scar pregnancies managed by suction curettage alone or in combination with other therapeutic procedures: A series of 33 cases and analysis of complication profile.
abstract: OBJECTIVE
  The aim of this study was to review our exogenous cesarean scar pregnancy (CSP) cases that were managed through transabdominal ultrasound (TAUS)-guided suction curettage either alone or with a concomitant additional therapeutic modality. The study was carried out over a 6-year period and we compared clinical outcomes, success rates and complication profiles between the two therapeutic approaches.
  
  
  METHODS
  A total of 33 exogenous CSP patients who were managed by suction curettage were extracted from the medical records. The patients were analyzed according to the intervention applied in the two groups as: TAUS-guided suction curettage alone (Group 1); and additional therapeutic tools, such as systemic or intracavitary administration of methotrexate and intracavitary ethanol instillation, in combination with suction curettage (Group 2). Basic demographic and clinical characteristics of women experiencing hemorrhagic complications and those who did not after the treatment were also compared.
  
  
  RESULTS
  There were no cases of uterine perforation, hysterectomy or unresponsiveness to treatment in our analyzed CSP cases. Four patients, two in each group, required blood transfusion. Our success rate in the overall patient population was 87.8% (29/33). Fourteen out of 16 patients who were treated with TAUS-guided suction curettage alone, and 15 out of 17 patients who received other interventional treatment modalities preceding suction curettage revealed successful resolution of the CSP without any complication (P = 0.948). Clinical and demographic characteristics of women who experienced any hemorrhagic complication did not significantly differ from those who did not.
  
  
  CONCLUSIONS
  In appropriate CSP cases, TAUS-guided suction curettage appears to be a reliable treatment option with acceptable success rates and similar complication profile to other therapeutic options.
authors.affiliation: Department of Obstetrics and Gynecology, Istanbul Medeniyet University, Faculty of Medicine, Istanbul, Turkey.
authors.forename: Özkan
authors.initials: Ö
authors.lastname: Özdamar
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, Kocaeli University, Kocaeli, Turkey.
authors.forename: Emek
authors.initials: E
authors.lastname: Doğer
authors.affiliation: Department of Obstetrics and Gynecology, Adana Training and Research Hospital, Adana, Turkey.
authors.forename: Sefa
authors.initials: S
authors.lastname: Arlıer
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, Kocaeli University, Kocaeli, Turkey.
authors.forename: Yiğit
authors.initials: Y
authors.lastname: Çakıroğlu
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, Bahçeşehir University, Istanbul, Turkey.
authors.forename: Rahime Nida
authors.initials: RN
authors.lastname: Ergin
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, Kocaeli University, Kocaeli, Turkey.
authors.forename: Şule Yıldırım
authors.initials: ŞY
authors.lastname: Köpük
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, Bahçeşehir University, Istanbul, Turkey.
authors.forename: Eray
authors.initials: E
authors.lastname: Çalışkan
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix / Q000150:complications; D000431:Ethanol / Q000627:therapeutic use; D005260:Female; D058746:Gestational Sac / Q000473:pathology*; D006801:Humans; D007322:Instillation, Drug; D008727:Methotrexate / Q000627:therapeutic use; D011183:Postoperative Complications; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography; D014619:Vacuum Curettage / Q000009:adverse effects / Q000379:methods*
chemical_list: D000431:Ethanol; D008727:Methotrexate
keywords: blood transfusion; cesarean scar pregnancy; suction curettage