{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T20:30:37Z","timestamp":1790800237598,"version":"4.1.0"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T00:00:00Z","timestamp":1624492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Cesarean scar pregnancy (CSP) involves a rare form of placental attachment that often leads to life-threatening conditions. The best treatment for CSP has been debated for decades. We aimed to evaluate the different treatments for CSP and analyzed the risk factors for intraoperative hemorrhage.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> CSP patients treated at the Affiliated Hospital of Jiangnan University were reviewed retrospectively from January 2014 to 2020. CSP was classified into three types based on the location and shape of gestational tissue, blood flow features, and thickness of the myometrium at the incision site. The clinical characteristics, types, approaches of treatment, and clinical outcomes of CSP were analyzed.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> A total of 55 patients were included in this study, 29 (52.7%) of whom underwent transvaginal curettage after uterine artery embolization (UAE) and 22 (40%) of whom underwent transabdominal ultrasound-guided hysteroscopic curettage (USHC) in type I and II. Four patients (7.3%) classified as type III underwent laparoscopic cesarean scar resection (LCSR). Intraoperative blood loss, blood transfusion rate, and scar diverticulum were significantly higher in type II than in type I (<jats:italic>P<\/jats:italic> &amp;lt; 0.05). Even though USHC showed no differences in intraoperative blood loss, length of stay, and scar diverticulum compared with curettage after UAE (<jats:italic>P<\/jats:italic> &amp;gt; 0.05), superiority was found in surgical time and hospitalization cost (<jats:italic>P<\/jats:italic> &amp;lt; 0.05). Furthermore, the type of CSP (OR = 10.53, 95% CI: 1.69\u201365.57; <jats:italic>P<\/jats:italic> = 0.012) and diameter of the gestational sac (OR = 25.76, 95% CI: 2.67\u2013248.20; <jats:italic>P<\/jats:italic> = 0.005) were found to be risk factors for intraoperative hemorrhage.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> Transabdominal ultrasound-guided hysteroscopic curettage is an effective and relatively safe treatment option for patients with CSP. Type of CSP and diameter of the gestational sac were found to be associated with excessive intraoperative hemorrhage.<\/jats:p>","DOI":"10.3389\/fmed.2021.682368","type":"journal-article","created":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T05:07:01Z","timestamp":1624511221000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":30,"title":["Approaches in the Treatment of Cesarean Scar Pregnancy and Risk Factors for Intraoperative Hemorrhage: A Retrospective Study"],"prefix":"10.3389","volume":"8","author":[{"given":"Yaying","family":"Lin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang","family":"Xiong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunlin","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinjin","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,6,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1016\/j.ejogrb.2016.02.039","article-title":"Reproductive outcomes following cesarean scar pregnancy - a case series and review of the literature","volume":"200","author":"Gao","year":"2016","journal-title":"Eur J Obstet Gynecol Reprod Biol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1016\/j.placenta.2011.11.010","article-title":"Placenta accreta: pathogenesis of a 20th century iatrogenic uterine disease","volume":"33","author":"Jauniaux","year":"2012","journal-title":"Placenta."},{"key":"B3","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1002\/uog.55","article-title":"Cesarean scar pregnancy","volume":"21","author":"Jurkovic","year":"2003","journal-title":"Ultrasound Obstet Gynecol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"556","DOI":"10.1002\/uog.12334","article-title":"Changes in Cesarean section scar dimensions during pregnancy: a prospective longitudinal study","volume":"41","author":"Naji","year":"2013","journal-title":"Ultrasound Obstet Gynecol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1016\/S0140-6736(09)61870-5","article-title":"Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08","volume":"375","author":"Lumbiganon","year":"2010","journal-title":"Lancet."},{"key":"B6","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1002\/uog.17568","article-title":"Outcome of Cesarean scar pregnancy managed expectantly: systematic review and meta-analysis","volume":"51","author":"Cali","year":"2018","journal-title":"Ultrasound Obstet Gynecol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"456","DOI":"10.1097\/GCO.0000000000000023","article-title":"Caesarean scar pregnancy: a review of management options","volume":"25","author":"Litwicka","year":"2013","journal-title":"Curr Opin Obstet Gynecol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"958","DOI":"10.1016\/j.fertnstert.2015.12.130","article-title":"Cesarean scar pregnancy: a systematic review of treatment studies","volume":"105","author":"Birch Petersen","year":"2016","journal-title":"Fertil Steril."},{"key":"B9","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1111\/1471-0528.12165","article-title":"Caesarean section and subsequent ectopic pregnancy: a systematic review and meta-analysis","volume":"120","author":"O'Neill","year":"2013","journal-title":"BJOG."},{"key":"B10","doi-asserted-by":"publisher","first-page":"6832094","DOI":"10.1155\/2016\/6832094","article-title":"Uterine rupture with cesarean scar heterotopic pregnancy with survival of the intrauterine twin","volume":"2016","author":"Lincenberg","year":"2016","journal-title":"Case Rep Obstet Gynecol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"e7327","DOI":"10.1097\/MD.0000000000007327","article-title":"Analysis of risk factors for intraoperative hemorrhage of cesarean scar pregnancy","volume":"96","author":"Ma","year":"2017","journal-title":"Medicine (Baltimore)."},{"key":"B12","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1016\/j.ijgo.2013.06.029","article-title":"Risk factors for intraoperative hemorrhage at evacuation of a cesarean scar pregnancy following uterine artery embolization","volume":"123","author":"Wang","year":"2013","journal-title":"Int J Gynaecol Obstet."},{"key":"B13","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1016\/j.ejogrb.2015.06.023","article-title":"Risk factors for intra-operative haemorrhage and bleeding risk scoring system for caesarean scar pregnancy: a case-control study","volume":"195","author":"Wang","year":"2015","journal-title":"Eur J Obstet Gynecol Reprod Biol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1007\/s00404-020-05877-9","article-title":"Risk factors for massive hemorrhage during the treatment of cesarean scar pregnancy: a systematic review and meta-analysis","volume":"303","author":"Zhang","year":"2021","journal-title":"Arch Gynecol Obstet."},{"key":"B15","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1097\/01.AOG.0000287295.39149.bd","article-title":"Recurrent ectopic pregnancy in a cesarean scar","volume":"111","author":"Holland","year":"2008","journal-title":"Obstet Gynecol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"568","DOI":"10.3760\/cma.j.issn.0529-567X.2016.08.003","article-title":"Expert opinion of diagnosis and treatment of cesarean scar pregnancy 2016","volume":"51","year":"2016","journal-title":"Chin J Obstet Gynecol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"e17741","DOI":"10.1097\/MD.0000000000017741","article-title":"Efficacy of contrast-enhanced ultrasound for diagnosis of cesarean scar pregnancy type","volume":"98","author":"Wu","year":"2019","journal-title":"Medicine (Baltimore)."},{"key":"B18","first-page":"142","article-title":"Pregnancy in a uterine scar sacculus\u2013an unusual cause of postabortal haemorrhage. A case report","volume":"53","author":"Larsen","year":"1978","journal-title":"S Afr Med J."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1663","DOI":"10.1111\/1471-0528.15255","article-title":"Caesarean scar pregnancy in the UK: a national cohort study","volume":"125","author":"Harb","year":"2018","journal-title":"BJOG."},{"key":"B20","doi-asserted-by":"publisher","first-page":"e0476","DOI":"10.1097\/MD.0000000000010476","article-title":"Therapeutic approach for the cesarean scar pregnancy","volume":"97","author":"Fu","year":"2018","journal-title":"Medicine (Baltimore)."},{"key":"B21","doi-asserted-by":"publisher","first-page":"592","DOI":"10.1046\/j.1469-0705.2000.00300-2.x","article-title":"Pregnancy in a cesarean scar","volume":"16","author":"Vial","year":"2000","journal-title":"Ultrasound Obstet Gynecol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1016\/S0301-2115(02)00003-9","article-title":"Conservative treatment by chemotherapy and uterine arteries embolization of a cesarean scar pregnancy","volume":"103","author":"Ghezzi","year":"2002","journal-title":"Eur J Obstet Gynecol Reprod Biol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1515\/jpm-2017-0189","article-title":"Expectant management of caesarean scar ectopic pregnancy: a systematic review","volume":"46","author":"Jayaram","year":"2018","journal-title":"J Perinat Med."},{"key":"B24","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1016\/j.ajog.2012.03.007","article-title":"Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy. A review","volume":"207","author":"Timor-Tritsch","year":"2012","journal-title":"Am J Obstet Gynecol."},{"key":"B25","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1016\/j.jmig.2015.04.008","article-title":"Local methotrexate injection as the first-line treatment for cesarean scar pregnancy: review of the literature","volume":"22","author":"Cheung","year":"2015","journal-title":"J Minim Invasive Gynecol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"e22845","DOI":"10.1097\/MD.0000000000022845","article-title":"A comparison between laparoscopy and hysteroscopy approach in treatment of cesarean scar pregnancy","volume":"99","author":"Zhang","year":"2020","journal-title":"Medicine (Baltimore)."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1075","DOI":"10.1111\/j.0001-6349.2005.00727.x","article-title":"Arterial embolization and prophylactic catheterization for the treatment for severe obstetric hemorrhage*","volume":"84","author":"Ojala","year":"2005","journal-title":"Acta Obstet Gynecol Scand."},{"key":"B28","doi-asserted-by":"publisher","first-page":"263","DOI":"10.4293\/108680813X13654754535197","article-title":"Laparoscopic management or laparoscopy combined with transvaginal management of type II cesarean scar pregnancy","volume":"17","author":"Wang","year":"2013","journal-title":"JSLS."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1996","DOI":"10.1093\/humrep\/dem105","article-title":"Loss of ovarian reserve after uterine artery embolization: a randomized comparison with hysterectomy","volume":"22","author":"Hehenkamp","year":"2007","journal-title":"Hum Reprod."},{"key":"B30","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1016\/S1701-2163(15)30632-0","article-title":"Laparoscopic myomectomy versus uterine artery embolization: long-term impact on markers of ovarian reserve","volume":"36","author":"Arthur","year":"2014","journal-title":"J Obstet Gynaecol Can."},{"key":"B31","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1111\/jog.13267","article-title":"Clinical classification and treatment of cesarean scar pregnancy","volume":"43","author":"Zhang","year":"2017","journal-title":"J Obstet Gynaecol Res."},{"key":"B32","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1016\/j.tjog.2015.08.006","article-title":"Reproductive outcomes after previous cesarean scar pregnancy: Follow up of 189 women","volume":"54","author":"Wang","year":"2015","journal-title":"Taiwan J Obstet Gynecol."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.682368\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T05:07:04Z","timestamp":1624511224000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.682368\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,24]]},"references-count":32,"alternative-id":["10.3389\/fmed.2021.682368"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2021.682368","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,24]]},"article-number":"682368"}}