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Quantitative risk assessment to guide the treatment of cesarean scar pregnancy
Author(s) -
Fang Qingxian,
Sun Li,
Tang Yunhui,
Qian Cuifeng,
Yao Xiaoying
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.12240
Subject(s) - medicine , odds ratio , hemostasis , confidence interval , foley catheter , pregnancy , dilation and curettage , receiver operating characteristic , foley , retrospective cohort study , misoprostol , logistic regression , surgery , ultrasound , obstetrics , catheter , radiology , abortion , biology , genetics
Objective To develop a risk‐factor scoring system for the prediction of bleeding during ultrasound‐guided dilation and curettage (D&C) for cesarean scar pregnancy ( CSP ). Methods The retrospective study included patients with a CSP of 31–67 days who underwent transabdominal ultrasonography‐guided D&C in 2010–2014. Binary logistic regression analysis was used to identify risk factors for the need of Foley catheter hemostasis. The predictive accuracy of a risk‐scoring system based on significant factors was evaluated by receiver operating curve analysis. Results Among 82 included patients, 66 (80%) were successfully treated without any complications, whereas 16 (20%) required Foley catheter compression hemostasis. Four patients who received the Foley catheter needed further treatment. A longer pregnancy duration (odds ratio 1.171, 95% confidence interval 1.050–1.305; P= 0.004) and a rich blood supply on ultrasonography (odds ratio 3.282, 95% confidence interval 1.441–4.742; P= 0.005) were significant risk factors for the need of compression hemostasis. A scoring system based on these two risk factors would have identified 93.8% of patients requiring compression hemostasis if the optimum cutoff score was used. Conclusion Heavy bleeding during transabdominal ultrasound‐guided D&C for CSP is associated with a longer pregnancy duration and a rich blood supply on ultrasonography. The new risk‐scoring system can be used to predict bleeding during surgery.