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.

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 Risk factors for poor hemostasis of prophylactic uterine artery embolization before curettage in cesarean scar pregnancy

2020 ◽  
Vol 48 (10) ◽  
pp. 030006052096437
Author(s):  
Hongan Tian ◽  
Shunzhen Li ◽  
Wanwan Jia ◽  
Kaihu Yu ◽  
Guangyao Wu
Keyword(s):  
Risk Factors ◽  
Blood Supply ◽  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Embolic Agent ◽  
Artery Embolization ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Hemorrhage Volume ◽  
Gestational Sac

Objective To observe the hemostatic effect of prophylactic uterine artery embolization (UAE) in patients with cesarean scar pregnancy (CSP) and to examine the risk factors for poor hemostasis. Methods Clinical data of 841 patients with CSP who underwent prophylactic UAE and curettage were retrospectively analyzed to evaluate the hemorrhage volume during curettage. A hemorrhage volume ≥200 mL was termed as poor hemostasis. The risk factors of poor hemostasis were analyzed and complications within 60 days postoperation were recorded. Results Among the 841 patients, 6.30% (53/841) had poor postoperative hemostasis. The independent risk factors of poor hemostasis were gestational sac size, parity, embolic agent diameter (>1000 μm), multivessel blood supply, and incomplete embolization. The main postoperative complications within 60 days after UAE were abdominal pain, low fever, nausea and vomiting, and buttock pain, with incidence rates of 71.22% (599/841), 47.44% (399/841), 39.12% (329/841), and 36.39% (306/841), respectively. Conclusions Prophylactic UAE before curettage in patients with CSP is safe and effective in reducing intraoperative hemorrhage. Gestational sac size, parity, embolic agent diameter, multivessel blood supply, and incomplete embolization of all arteries supplying blood to the uterus are risk factors of poor hemostasis.

scholarly journals Clinical analysis of mifepristone combined with transabdominal ultrasound-guided suction and curettage for different types of scar pregnancy

2021 ◽  
Author(s):  
Hongmei Lian ◽  
dejun chen ◽  
Jingxia Zheng ◽  
Ling Zhang
Keyword(s):  
Clinical Analysis ◽  
Type I ◽  
Type Ii ◽  
Transabdominal Ultrasound ◽  
Ultrasound Guided ◽  
Cesarean Scar Pregnancy ◽  
Type Iii ◽  
Suction Curettage ◽  
Β Hcg ◽  
Child Hospital

Abstract Background Cesarean scar pregnancy (CSP) is a life-threatening condition without consensus on treatment. The purpose of this study was to evaluate the safety, efficacy, and outcome of mifepristone combined with transabdominal ultrasound-guided suction and curettage (TUSC) in the treatment of CSP. Methods CSP patients who treated with mifepristone combined TUSC at Maternal and Child Hospital of Hubei Province from 2013 to 2015 was retrospectively analyzed. Patients were divides into three types based on the newest classification criteria in China. Clinical information and outcomes were analyzed. Results 157 CSP patients were included, with 96 type I cases, 56 type II cases and 5 type III cases. No significant differences in age, gravity, parity, gestational age and initial β-human chorionic gonadotropin (β-hCG) levels among the three types. All patients were successfully treated with mifepristone combined with TUSC. No one needed emergency blood transfusion or another treatment. After mifepristone combined with TUSC treatment, the percentage changes of the β-hCG levels were similar in all CSP types. The average of intraoperative blood loss in type I patients during suction curettage was lower than in type II and type III, and more Foley catheters were inserted into the uterus in type II and type III than type I patients to achieve hemostasis. Conclusion Mifepristone combined with TUSC appears to be a safety and efficacy treatment option to all types of CSP.

scholarly journals Evaluation of the Treatment of High Intensity Focused Ultrasound Combined With Suction Curettage for Exogenous Cesarean Scar Pregnancy

2021 ◽  
Author(s):  
Lin Mu ◽  
Huifang Weng ◽  
Xiaoyun Wang
Keyword(s):  
Blood Loss ◽  
High Intensity ◽  
Focused Ultrasound ◽  
High Intensity Focused Ultrasound ◽  
Control Group ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Suction Curettage ◽  
Gestational Sac ◽  
The Mean

Abstract Purpose: To evaluate the effectiveness of high intensity focused ultrasound (HIFU) combined with suction curettage in the treatment of exogenous cesarean scar pregnancy (CSP). Methods: A total of 41 patients diagnosed with exogenous CSP were enrolled in this study. All patients received HIFU treatment combined with suction curettage. Results: Twenty-nine patients were administered one session of HIFU ablation. In addition, the other 12 patients received 2 HIFU sessions. Suction curettage was performed in all patients after HIFU, and no patient was converted to laparoscopy or hysterectomy. The mean blood loss during suction curettage was 99 ml. Three patients received two sessions of suction curettage. The success rate of our study was 92.68%. The mean time for serum β-HCG normalization was 23.18±3.13 days. The average menstruation recovery time was 29.38±3.34 days. Based on the blood loss during suction curettage, 41 patients were divided into a bleeding group and a control group. The size of the gestational sac in the bleeding group (3.80±0.87 cm) was larger than that in the control group (3.39±0.77 cm) (P <0.05). The thickness of the myometrium between the bladder and gestational sac in the bleeding group (2.37±0.89 mm) was less than that in the control group (2.75±0.75 mm) (P <0.05). Conclusion: The results suggested that HIFU combined with suction curettage could be considered an effective treatment for exogenous CSP of < 9 weeks. The size of the gestational sac and the thickness of the myometrium between the bladder and gestational sac might be high-risk factors for blood loss during this treatment.

Postoperative acute kidney injury in living donor liver transplantation recipients

2017 ◽  
Vol 41 (1) ◽  
pp. 37-42 ◽  
Author(s):  
Hakan K. Atalan ◽  
Bulent Gucyetmez ◽  
Serdar Aslan ◽  
Serafettin Yazar ◽  
Kamil Y. Polat
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Acute Kidney Injury ◽  
Blood Loss ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Kidney Injury ◽  
Intraoperative Blood Loss ◽  
Donor Liver ◽  
Donor Liver Transplantation

Purpose: There are many risk factors for postoperative acute kidney injury in liver transplantation. The aim of this study is to investigate the risk factors for postoperative acute kidney injury in living donor liver transplantation recipients. Methods: 220 living donor liver transplantation recipients were retrospectively evaluated in the study. According to the Kidney Disease Improving Global Outcomes Guidelines, acute kidney injury in postoperative day 7 was investigated for all patients. The patient’s demographic data, preoperative and intraoperative parameters, and outcomes were recorded. Results: Acute kidney injury was found in 27 (12.3%) recipients. In recipients with acute kidney injury, female population, model for end-stage liver disease score, norepinephrine requirement, duration of mean arterial pressure less than 60 mmHg, the usage of gelatin and erythrocyte suspension and blood loss were significantly higher than recipients with nonacute kidney injury (for all p<0.05). In multivariate analyses, the likelihood of acute kidney injury on postoperative day 7 were increased 2.8-fold (1.1-7.0), 2.7-fold (1.02-7.3), 3.4-fold (1.2-9.9) and 5.1-fold (1.7-15.0) by postoperative day 7, serum tacrolimus level ≥10.2 ng dL−1, intraoperative blood loss ≥14.5 mL kg−1, the usage of gelatin >5 mL kg−1 and duration of MAP less than 60 mmHg ≥5.5 minutes respectively (for all p<0.05). Conclusions: In living donor liver transplantation recipients, serum tacrolimus levels, intraoperative blood loss, hypotension period and the usage of gelatin may be risk factors for acute kidney injury in the early postoperative period.

Local intra-gestational sac methotrexate injection followed by dilation and curettage in treating cesarean scar pregnancy

2020 ◽  
Vol 302 (2) ◽  
pp. 439-445 ◽  
Author(s):  
Kai-Liang Tan ◽  
Li Jiang ◽  
Yu-Mei Chen ◽  
Ying Meng ◽  
Bang-Quan Lv ◽  
...  
Keyword(s):  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Dilation And Curettage ◽  
Gestational Sac

Risk factors for postoperative systemic complications in elderly patients with brain tumors

2009 ◽  
Vol 111 (2) ◽  
pp. 258-264 ◽  
Author(s):  
Kenichiro Asano ◽  
Takahiro Nakano ◽  
Tetsuji Takeda ◽  
Hiroki Ohkuma
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Brain Tumors ◽  
Blood Loss ◽  
Elderly Patients ◽  
Univariate Analysis ◽  
Intraoperative Blood Loss ◽  
Systemic Complications ◽  
Level Difference ◽  
Cutoff Values

Object In elderly patients with brain tumors, the prevention of postoperative systemic complications is extremely important, and identification of the risk factors would be useful for planning therapy. The authors investigated ways to avoid postoperative complications by identifying risk factors. Methods The study population included 84 patients, 70 years of age or older, who underwent surgical brain tumor removal. The following independent factors were assessed by univariate and multivariate analyses: sex, age, preoperative underlying diseases and complications, histopathological findings, preoperative Karnofsky Performance Scale (KPS) score, preoperative whole blood hemoglobin (Hb) level, preoperative serum total protein (TP) level, operation time, intraoperative blood loss, change in Hb level (difference between pre- and postoperative values), and change in TP level (difference between pre- and postoperative values). The cutoff values for significant independent factors were also determined. Results Overall, 35 (41.7%) of the 84 patients had a total of 56 postoperative systemic complications. Univariate analysis identified the preoperative KPS score, intraoperative blood loss, change in Hb level, and change in TP level as risk factors for postoperative complications, and multivariate analysis extracted the following risk factors: the preoperative KPS score (p = 0.0450, OR 4.020), intraoperative blood loss (p = 0.0104, OR 6.571), and change in Hb levels (p = 0.0023, OR 9.301). The cutoff values were: KPS score < 80%, intraoperative blood loss ≥ 350 ml, and change in Hb level ≥ 2.0 g/dl. Conclusions In elderly patients with brain tumors, low preoperative KPS score, high intraoperative blood loss, and a large difference between pre- and postoperative Hb levels are significant risk factors for postoperative systemic complications.

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