Management and reproductive outcomes following cesarean scar pregnancy: experiences of two tertiary centers in a cohort of 60 women

Year 2024, Volume: 5 Issue: 5, 256 - 264, 26.10.2024

Zeynep Şeyhanlı , Burak Bayraktar , Gülşan Karabay , Mevlüt Bucak , Nazan Vanlı Tonyalı , Gizem Aktemur , Betül Tokgöz , Büşra Demir Çendek , Şevki Çelen , Ali Çağlar , Yaprak Üstün

Abstract

Aims: This study aims to analyze the treatment approaches and reproductive outcomes of women diagnosed with cesarean scar pregnancy (CSP).
Methods: A retrospective analysis was conducted on sixty patients diagnosed with CSP between January 2020 and December 2023 at two tertiary centers with a combined total of 49,733 births during the study period. Demographic, clinical, and laboratory characteristics, complications, treatment methods, and reproductive outcomes were examined. Patients were categorized into two groups based on their treatment approach: isolated treatment (n=45, 75%) and combined treatment (n=15, 25%), and the
outcomes of the two groups were compared.
Results: The mean age of all patients was 34 years (±5.5) (range: 21-46). The mean gestational age at admission was 6.86 weeks (±1.82), with 35% showing positive fetal heartbeats. Complications occurred in 28.3% of cases, with hematomas being the most common (26.7%). The combined treatment group had higher rates of blood transfusions and complications, including hematomas and bladder injuries (p=0.005 and p<0.001, respectively). Of the 16 patients (26.7%) who desired future pregnancy, 14 successfully conceived. Among these pregnancies, 7 resulted in early pregnancy loss, while 7 resulted in live births, all of which were delivered after 35 weeks of gestation.
Conclusion: Early diagnosis and evidence-based treatment of CSP are essential for preventing life-threatening obstetric complications. Larger, prospective studies are required to establish optimal diagnostic and treatment strategies.

Keywords

Cesarean scar pregnancy, treatment, treatment approaches, reproductive outcome

Ethical Statement

Ethics Committee Approval: The study was initiated with the approval of the Ankara Etlik City Hospital Ethics Committee (Approval No. AESH-EK1-2023-683 ).

Supporting Institution

Financial Disclosure: The authors declared that this study has received no financial support.

Thanks

Acknowledgment: The authors extend their sincere admiration and appreciation to Prof. Dr. Can Tekin Iskender, whose profound expertise and experience significantly advanced our scientific progress and passed away so early.

Sezaryen skar gebeliği sonrası yönetim ve reprodüktif sonuçlar: 60 kadından oluşan bir kohortta iki üçüncül merkezin deneyimler

Abstract

Amaçlar: Bu çalışmanın amacı sezaryen skar gebeliği (CSP) tanısı almış kadınların tedavi yaklaşımlarını ve reprodüktif sonuçlarını analiz etmektir.
Yöntemler: Ocak 2020 ile Aralık 2023 tarihleri arasında, toplamda 49,733 doğumun gerçekleştiği iki üçüncü basamak merkezde CSP tanısı konmuş altmış hastanın retrospektif analizi yapıldı. Demografik, klinik ve laboratuvar özellikler, komplikasyonlar, tedavi yöntemleri ve reprodüktif sonuçlar incelendi. Hastalar, uygulanan tedavi yöntemine göre iki gruba ayrıldı: izole tedavi uygulananlar (n=45, %75) ve kombine tedavi uygulananlar (n=15, %25) ve bu grupların sonuçları karşılaştırıldı.
Sonuçlar: Hastaların ortalama yaşı 34 yıl (±5.5) (aralık: 21-46) idi. Başvuru sırasındaki ortalama gebelik yaşı 6.86 hafta (±1.82) olup, vakaların %35'inde fetal kalp atımı pozitif olarak saptandı. Vakaların %28.3'ünde komplikasyonlar gelişti ve en yaygın komplikasyon hematomdu (%26.7). Kombine tedavi grubunda kan transfüzyonu ve hematom ile mesane yaralanması gibi komplikasyonlar daha yüksek oranlarda görüldü (sırasıyla p=0.005 ve p<0.001). Tekrar gebelik isteyen 16 hastanın (%26.7) 14’ü başarılı bir şekilde gebe kaldı. Bu gebeliklerden 7’si erken gebelik kaybı ile sonuçlanırken, 7’si 35 haftadan sonra canlı doğumla sonuçlandı.
Tartışma: CSP'nin erken teşhisi ve kanıta dayalı tedavisi, hayatı tehdit eden obstetrik komplikasyonların önlenmesinde kritik öneme sahiptir. Optimal tanı ve tedavi stratejilerini belirlemek için daha geniş, prospektif çalışmalara ihtiyaç vardır.

Keywords

Sezaryen skar gebeliği, tedavi, tedavi yaklaşımları, reprodüktif sonuçlar

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