The effect of ultrasound-guided suction curettage on reproductive outcomes in patients with cesarean scar pregnancy

Abstract

The effect of ultrasound-guided suction curettage on reproductive outcomes in patients with cesarean scar pregnancy

Abstract

Objective: This study aims to evaluate reproductive and pregnancy outcomes in patients with cesarean scar pregnancies (CSP) treated by suction curettage. Methods: This retrospective observational study included 85 patients with CSP treated by suction curettage in a university hospital between 2013-2017. Reproductive status of the patients who could be reached by phone was inquired at 6-month intervals for three years. Results: Hospital records and telephone follow-up data of the 44 patients who completed follow-up were analyzed. Nineteen patients did not desire pregnancy, while 25 patients reported wishing to conceive again. Twenty-three of these patients (92%, 23/25) conceived spontaneously, 2 of them (8%, 2/25) unable to conceive due to unexplained secondary infertility. Mean length of time from CSP to subsequent pregnancy was 12.3 months (range 2-36 months). Of these pregnancies, 11 (47.8%, 11/23) resulted in birth without any obstetrical problems. Six patients (26%, 6/23) experienced miscarriage, and three patients (13%, 3/23) recurrent cesarean scar pregnancies. Two patients (8.6%, 2/23) had abnormal placental invasion and one patient (4.3%, 1/23) tubal ectopic pregnancy. The live birth rate among the pregnancies was 52.1% (12/23). Conclusion: There is no consensus on the primary treatment regarding the reproductive outcomes. Suction curettage is a successful, reliable, inexpensive and easily applicable treatment when appropriate patients are selected. Furthermore, it has a minimal negative effect on fertility, so it can be considered as a first-line treatment option in patients who wish to have children in the future.

Keywords

• Cesarean scar pregnancy
• fertility outcomes
• pregnancy outcomes

References

1. 1.Graesslin O, Dedecker F, Quereux C, et al.Conservative treatment of ectopic pregnancy in acesarean scar Obstetrics & Gynecology 2005; 105:869-71.
2. 2.Wang S, Li Y, Ma X. Lower uterine segmentthickness in assessing whether cesarean scarpregnancy patients could be treated with suctioncurettage. J Matern Fetal Neonatal Med. 2018.https://doi.org/10.1080/14767058.2018.1531118.
3. 3.Jurkovic D, Hillaby K, Woelfer B, et al. First‐trimester diagnosis and management of pregnanciesimplanted into the lower uterine segment cesareansection scar Ultrasound