Risk factors associated with failure of treatment for cesarean scar pregnancy.
OBJECTIVE
To identify risk factors associated with treatment failure among women with cesarean scar pregnancy (CSP).


METHODS
In a retrospective study, the medical records of patients with CSP treated at National Taiwan University Hospital, Taipei, Taiwan, from 1994 to 2015 were reviewed. The women were managed primarily with hysterotomy, evacuation, or methotrexate. Receiver operating characteristic (ROC) curve analysis and logistic regression analysis were used to evaluate the factors associated with treatment failure.


RESULTS
Among 90 patients, 44 underwent hysterotomy, 18 underwent evacuation, and 28 received methotrexate. The success rates were 100% (44/44) for hysterotomy, 83% (15/18) for evacuation, and 57% (16/28) for methotrexate (P<0.001). ROC curve analysis indicated that a pregnancy length of 8 weeks and a mean sac diameter (MSD) of 4 cm were both predictive of failure of treatment by primary evacuation and methotrexate. In multivariate logistic regression analysis, an MSD of 4 cm or more was the only independent risk factor for treatment failure (odds ratio 68.99, 95% confidence interval 6.27-759.60; P=0.001).


CONCLUSIONS
Primary hysterotomy was suitable for treatment of CSP of any size. Failure of primary evacuation or methotrexate usually occurred when the MSD was larger than 4 cm.
Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Ying-Cheng
YC
Chiang
Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Yi-An
YA
Tu
Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Jehn-Hsiahn
JH
Yang
Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Shin-Yu
SY
Lin
Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Chien-Nan
CN
Lee
Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Jin-Chung
JC
Shih
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix / Q000150:complications*; D005260:Female; D006801:Humans; D020883:Hysterotomy; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D016216:Ultrasonography, Prenatal; D055815:Young Adult
D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate
Cesarean scar pregnancy; Evacuation; Hysterotomy; Mean sac diameter; Methotrexate