Premium
Risk factors associated with failure of treatment for cesarean scar pregnancy
Author(s) -
Chiang YingCheng,
Tu YiAn,
Yang JehnHsiahn,
Lin ShinYu,
Lee ChienNan,
Shih JinChung
Publication year - 2017
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.12157
Subject(s) - medicine , hysterotomy , odds ratio , logistic regression , confidence interval , retrospective cohort study , methotrexate , receiver operating characteristic , pregnancy , surgery , medical record , obstetrics , gestation , genetics , biology
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). Conclusion 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.