scholarly journals A Comparison of Ultrasound Guided Curettage With and Without Uterine Artery Embolization on Controlling Intraoperative Blood Loss for a Cesarean Scar Pregnancy Treatment: Study Protocol for a Randomized Clinical Trial

2021 ◽  
Vol 12 ◽  
Author(s):  
Yunhui Tang ◽  
Yi Zhang ◽  
Hanqing Tang ◽  
Jiahui Che ◽  
Hua Feng ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Blood Loss ◽  
Randomized Clinical Trial ◽  
Intraoperative Blood Loss ◽  
Ultrasound Guided ◽  
Artery Embolization ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Risk Scoring ◽  
Risk Scoring System

IntroductionCesarean scar pregnancy affects 6% of all ectopic pregnancies in women with prior cesarean section, and there is currently no consensus on the optimal treatment. Options of surgical treatment have a risk of intraoperative blood loss; therefore, uterine artery embolization (UAE) has been considered as an option of reducing intraoperative blood loss. However, UAE may be overused in clinical practice, especially in China. We present this protocol for a randomized clinical trial investigating the necessity of performing UAE for cesarean scar pregnancy, in combination with surgical suction curettage, taking into account the different subtypes of cesarean scar pregnancy. We recently developed a risk-scoring system (QRS) to estimate intraoperative blood loss, with 93.8% sensitivity and 6.3% false negative. Through this randomized clinical trial, we will retrospectively validate the QRS score on predicting intraoperative blood loss.Methods and AnalysisWe propose undertaking a randomized clinical trial sequentially recruiting 200 patients. All the patients will randomly receive ultrasound guided curettage with or without UAE. Data on the subtypes of cesarean scar pregnancy (Types 1 and II and III) detected by ultrasound will be collected before operation. The score on estimating intraoperative blood loss assessed by our recently developed quantitative risk-scoring system (QRS) will be collected before the operation. We will primarily compare the duration of the operation, intraoperative blood loss, and complications between the two groups. We will also retrospectively analyze the association of subtypes of cesarean scar pregnancy and the options of treatment and validate the QRS score. Outcomes of subsequent pregnancy within the 2-year follow-up will be secondary outcomes.Trial Registration Number[website], identifier ChiCTR2100041654.

scholarly journals Approaches in the Treatment of Cesarean Scar Pregnancy and Risk Factors for Intraoperative Hemorrhage: A Retrospective Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Yaying Lin ◽  
Chang Xiong ◽  
Chunlin Dong ◽  
Jinjin Yu
Keyword(s):  
Risk Factors ◽  
Blood Loss ◽  
Tissue Blood Flow ◽  
Type I ◽  
Transabdominal Ultrasound ◽  
Intraoperative Blood Loss ◽  
Ultrasound Guided ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Gestational Sac

Background: 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.Methods: 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.Results: 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 (P < 0.05). Even though USHC showed no differences in intraoperative blood loss, length of stay, and scar diverticulum compared with curettage after UAE (P > 0.05), superiority was found in surgical time and hospitalization cost (P < 0.05). Furthermore, the type of CSP (OR = 10.53, 95% CI: 1.69–65.57; P = 0.012) and diameter of the gestational sac (OR = 25.76, 95% CI: 2.67–248.20; P = 0.005) were found to be risk factors for intraoperative hemorrhage.Conclusions: 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.

Effectiveness of tranexamic acid on intraoperative blood loss in isolated Le Fort I osteotomies – A prospective, triple blinded randomized clinical trial

2014 ◽  
Vol 42 (7) ◽  
pp. 1221-1224 ◽  
Author(s):  
Amelia Christabel ◽  
M.R. Muthusekhar ◽  
Vinod Narayanan ◽  
Yashoda Ashok ◽  
Chen Loong Soh ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Randomized Clinical Trial ◽  
Intraoperative Blood Loss ◽  
Le Fort ◽  
Le Fort I

scholarly journals Role of collateral embolization in addition to uterine artery embolization followed by hysteroscopic curettage for the management of cesarean scar pregnancy

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Guodong Zhang ◽  
Jijun Li ◽  
Jun Tang ◽  
Lei Zhang ◽  
Dechao Wang ◽  
...  
Keyword(s):  
Blood Loss ◽  
Pelvic Pain ◽  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Artery Embolization ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
The Mean ◽  
Baseline Characteristics ◽  
Β Hcg

Abstract Background The aim of this study was to assess the feasibility, safety and outcome of the embolization of non-gonadal collateral supplying gestational sac (GS) in addition to uterine artery embolization (UAE), followed by hysteroscopic curettage for the management of cesarean scar pregnancy (CSP). Methods A retrospective study was undertaken from January 2012 to September 2018 in 24 CSP patients in whom non-gonadal collaterals supplying GS were identified by arterial angiography performed immediately after UAE. These patients underwent attempt collateral embolization in addition to UAE, followed by hysteroscopic curettage for the management of CSP. The 24 patients were divided into two groups based on whether they underwent technically successful collateral embolization (UAE-SCE group) or failed collateral embolization (UAE-FCE group) in addition to UAE. The baseline characteristics and clinical outcomes including time for serum β-human chorionic gonadotropin (β-hCG) levels normalization, blood loss, secondary anemia, and pelvic pain were compared between the two groups. The paired t test and Man Whitney test were used for comparisons of discrete and numerical variables, respectively. Results Collateral embolization was techinically successful in 16 (66.7%, 16/24) patients and failed in the other 8 (33.3%, 8/24) patients. There were no significant differences between the two groups in baseline characteristics. The mean blood loss and secondary anemia in the UAE-SCE group were significantly less than UAE-FCE group. No significant difference was found between the two groups in the mean time for β-hCG levels normalization and pelvic pain. Conclusions During the management of UAE combined with hysteroscopic curettage for CSP, additional embolization of non-gonadal collateral supplying GS during UAE is feasible and safe in patients with non-gonadal collateral supplying GS, and the additional embolization of the collateral may reduce blood bloss related to hysteroscopic curettage.

scholarly journals When to Perform Curettage After Uterine Artery Embolization for Cesarean Scar Pregnancy: a Clinical Study

2021 ◽  
Author(s):  
Qiao Wang ◽  
Hongling Peng ◽  
Xia Zhao ◽  
Xiaorong Qi
Keyword(s):  
Cohort Study ◽  
Blood Loss ◽  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Optimal Time ◽  
Time Interval ◽  
Artery Embolization ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Treatment Interval

Abstract Background: Prophylactic uterine artery embolization (UAE) combined with following curettage was suggested as an effective and minimally invasive treatment strategy for cesarean scar pregnancy (CSP) with high bleeding risk. However, the timing of curettage after UAE remains to be studied. Thus, we aimed to identify the optimal time interval to perform curettage after UAE in patients with CSP.Methods: We conducted a retrospective cohort study in a large medical center for women and children in southwest China. CSP patients treated by UAE combined with following curettage were included and grouped by the treatment time interval between these two procedures. The clinical outcomes among arms were compared by univariate and multi-variable analysis.Results: Our study finally included a total of 314 CSP patients who received this combination treatment in our department from January 2014 to December 2019. The median time interval between UAE and curettage was 48 hours with a range of 12-168 hours in all participants. Thirty-two cases (10.2%) experienced intra-operative hemorrhage (blood loss ≥200mL). Seventeen cases (5.4%) used intrauterine balloon tamponade. Fourteen cases (4.5%) were converted into laparoscopy (or laparotomy). In the cohort study, patients with longer treatment interval had more intra-operative blood loss and higher incidence of complications than those with shorter interval (P＜0.05). The rate of intra-operative bleeding was 5.0% in patients who received curettage within 24 hours after UAE (Arm 1), in comparison with 19.4% in those who had treatment interval longer than 72 hours (Arm 4). In the multi-variable logistic regression model of bleeding, the treatment interval ＞72 hours had an adjusted odds ratio of 3.37 (95% confidence interval: 1.40-8.09). Conclusion: We suggest that curettage should not be delayed longer than 72 hours after UAE under general conditions.

scholarly journals Clinical Assessment of Ultrasound-Guided Local Lauromacrogol Injection Combined With Curettage and Hysteroscopy for Cesarean Scar Pregnancy

2020 ◽  
Vol 11 ◽  
Author(s):  
Qing Wu ◽  
Xia Liu ◽  
Lin Zhu ◽  
Yichen Zhu ◽  
Tingting Mei ◽  
...  
Keyword(s):  
Medication Cost ◽  
Complication Rates ◽  
Success Rates ◽  
Ultrasound Guided ◽  
Artery Embolization ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
Minimal Invasion

Background: To evaluate the efficacy, safeness and cost of ultrasound-guided local lauromacrogol injection (USG-LLI) combined with curettage and hysteroscopy for cesarean scar pregnancy (CSP).Methods: This was a retrospective study included 151 CSP patients diagnosed with CSP from June 2017 to December 2019, and treated by USG-LLI (n = 86) or uterine artery embolization (UAE) (n = 65) combined with curettage and hysteroscopy. Clinical data and outcome were analyzed.Results: There were no significant differences in basic clinical characteristics in the two groups. Two groups showed the similar success rates. USG-LLI group, compared with UAE group had significantly lower complication rates (9.30 vs. 44.62%), lower total costs (both medical and non-medication cost) (p < 0.05).Conclusions: USG-LLI combined with curettage and hysteroscopy is a feasible method to treat CSP with minimal invasion and high efficacy. Moreover, compared with curettage after UAE, USG-LLI exhibited lower complication rate and required fewer expenses.

scholarly journals Plasma Technology Reduces Blood Loss in Adolescent Idiopathic Scoliosis Surgery: A Prospective Randomized Clinical Trial

2020 ◽  
pp. 219256822092834
Author(s):  
Andrea Piazzolla ◽  
Davide Bizzoca ◽  
Giuseppe Solarino ◽  
Claudia Parato ◽  
Biagio Moretti
Keyword(s):  
Clinical Trial ◽  
Adolescent Idiopathic Scoliosis ◽  
Blood Loss ◽  
Idiopathic Scoliosis ◽  
Randomized Clinical Trial ◽  
Intraoperative Blood Loss ◽  
Prospective Randomized Clinical Trial ◽  
Group A ◽  
Bipolar Sealer ◽  
Group B

Study Design: Prospective randomized clinical trial. Objectives: To assess the effectiveness of PEAK Plasmablade (PPB), compared with bipolar sealer and standard electrocautery, in the posterior spinal instrumentation and fusion (PSF) surgery performed for adolescent idiopathic scoliosis (AIS). Methods: Ninety-three patients undergoing PSF surgery for AIS were randomized in 2 groups: group-A patients (n = 45) underwent PSF surgery using PPB; group-B patients (n = 48) were treated with bipolar sealer and standard electrocautery. Demographic and surgical data was recorded. All the patients underwent serial blood tests on the day before surgery (T0) and at 24 (T1), 48 (T2), 72 (T3), and 96 (T4) hours postoperatively. Visual analogue scale for pain (VAS) score, the percentage of paracetamol assumption, and the blood transfusion rate were recorded in the time-lapse T1 to T4. Intergroup variability was assessed. Pearson correlation test was performed. A P value <.05 was considered significant. Results: In group A, a significantly shorter total operative time ( P = .0087), a significantly lower total intraoperative blood loss (TBL) ( P = .001), and a higher postoperative hemoglobin (Hb) ( P = .01) were recorded. A significant higher mean Hb concentration and mean albumin value was recorded in group A at 24 and 48 hours postoperatively. A significant correlation between TBL and hospital stay was recorded in both groups (group A, P = .00 001; group B, P = .00 006); moreover, in both groups, a significant correlation was observed between TBL and mean VAS at 72 hours postoperatively (group A, P = .0009; group B, P = .0001) and at 96 hours postoperatively (group A, P = .000 044; group B, P = .00 001). Conclusions: PPB reduces the intraoperative blood loss in PSF performed for AIS, thus allowing a patient’s faster recovery.

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