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Clinical and ultrasound parameters in prediction of excessive hemorrhage during management of cesarean scar pregnancy

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


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Deyun Wang

Ting Gui, Ping Peng, Xinyan Liu, Li Jin, Weilin Chen

Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China

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

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