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Authors Gui T, Peng P, Liu X, Jin L, Chen W
Received 14 April 2017
Accepted for publication 13 June 2017
Published 30 June 2017 Volume 2017:13 Pages 807—812
DOI https://doi.org/10.2147/TCRM.S139682
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Akshita Wason
Peer reviewer comments 2
Editor who approved publication: Professor Deyun Wang
Precis: During the management
of cesarean scar pregnancy, gestational mass size >6 cm, uterine scar
thickness <0.2 cm, peak systolic velocity >70 cm/s, and
resistance index <0.35 are independent risk factors for excessive
hemorrhage.
Objective: The objective of this study was to investigate
risk factors associated with excessive hemorrhage during the management of
cesarean scar pregnancy (CSP).
Patients and methods: A retrospective case–control study was
conducted, including 40 patients who experienced excessive bleeding and 80
controls without severe hemorrhage.
Results: Six parameters (two clinical and four ultrasound
parameters) potentially related to excessive hemorrhage were analyzed.
Single-variable statistical analyses showed that the case group had higher
gestational age (74.1±23.6 days), higher pretreatment serum β-human
chorionic gonadotropin (HCG) level (46,201±32,294 mIU/mL), larger
gestational mass size (6.5±2.2 cm), thinner uterine scar thickness
(0.17±0.12 cm), and richer peritrophoblastic perfusion (peak systolic
velocity [PSV] 72.8±33.7 cm/s, resistance index [RI] 0.35±0.12), showing
statistical significance compared with the control group. Further multivariable
logistic regression analysis of the association between each of the risk
factors and hemorrhage confirmed that increased gestational mass size and PSV
were risk factors for hemorrhage (odds ratio [OR] 3.624, 95% confidence
interval [CI] [1.179–11.138] and OR 1.062, 95% CI [1.007–1.121]) and increased
uterine scar thickness and RI were protective factors against hemorrhage (OR
0.181, 95% CI [0.034–0.957] and OR 0.851, 95% CI [0.729–0.994]); however, there
was no statistical significance between the two clinical parameters.
Conclusion: Gestational mass size >6 cm, uterine
scar thickness <0.2 cm, PSV >70 cm/s, and RI <0.35 are
independent risk factors for excessive hemorrhage during the management of CSP.
Keywords: cesarean scar
pregnancy, excessive hemorrhage, ultrasound parameters, risk factors