TY - JOUR

T1 - Cesarean scar pregnancy

T2 - a systematic review of treatment studies

AU - Petersen, Kathrine Birch

AU - Hoffmann, Elise

AU - Rifbjerg Larsen, Christian

AU - Svarre Nielsen, Henriette

N1 - Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

PY - 2016/4

Y1 - 2016/4

N2 - OBJECTIVE: To study treatment modalities for cesarean scar pregnancies (CSPs), focusing on efficacy and complications in relation to study quality.DESIGN: Systematic review.SETTING: Not applicable.PATIENT(S): A total of 2,037 women with CSP.INTERVENTION(S): Review of MEDLINE, EMBASE, and Cochrane Library to find studies including five or more women. Data were extracted on primary treatment modality/efficacy, complications, and future fertility. The level of evidence was categorized according to Oxford Centre for Evidence-based Medicine guidelines. Quality was assessed using The Cochrane Collaboration's Risk of Bias Tools for Randomized Controlled Trials and the modified Delphi techniques for case series. Meta-analysis was impossible owing to multifarious treatments.MAIN OUTCOME MEASURE(S): Successful first-line treatment. Complications were hysterectomy, laparotomy, bleeding >1,000 mL, or blood transfusion.RESULT(S): Fifty-two studies were included: four randomized, controlled trials and 48 case series. Fifteen of the 52 analyzed studies were scored as high quality. Treatment modalities were condensed to 14 different approaches. Combining study quality, level of evidence, efficacy, and safety, five approaches for treating CSP are recommended, depending on availability, severity of patient symptoms, and surgical skills: [1] resection through a transvaginal approach, [2] laparoscopy, [3] uterine artery embolization in combination with dilatation and curettage and hysteroscopy, [4] uterine artery embolization in combination with dilatation and curettage, and [5] hysteroscopy.CONCLUSION(S): This review recommends treatment options for CSP in clinical practice, based on efficacy and safety. The literature supports an interventional rather than medical approach. Present recommendations are primarily based on case series. Multicenter, well-designed studies are needed to draw definite conclusions on how to treat CSP.

AB - OBJECTIVE: To study treatment modalities for cesarean scar pregnancies (CSPs), focusing on efficacy and complications in relation to study quality.DESIGN: Systematic review.SETTING: Not applicable.PATIENT(S): A total of 2,037 women with CSP.INTERVENTION(S): Review of MEDLINE, EMBASE, and Cochrane Library to find studies including five or more women. Data were extracted on primary treatment modality/efficacy, complications, and future fertility. The level of evidence was categorized according to Oxford Centre for Evidence-based Medicine guidelines. Quality was assessed using The Cochrane Collaboration's Risk of Bias Tools for Randomized Controlled Trials and the modified Delphi techniques for case series. Meta-analysis was impossible owing to multifarious treatments.MAIN OUTCOME MEASURE(S): Successful first-line treatment. Complications were hysterectomy, laparotomy, bleeding >1,000 mL, or blood transfusion.RESULT(S): Fifty-two studies were included: four randomized, controlled trials and 48 case series. Fifteen of the 52 analyzed studies were scored as high quality. Treatment modalities were condensed to 14 different approaches. Combining study quality, level of evidence, efficacy, and safety, five approaches for treating CSP are recommended, depending on availability, severity of patient symptoms, and surgical skills: [1] resection through a transvaginal approach, [2] laparoscopy, [3] uterine artery embolization in combination with dilatation and curettage and hysteroscopy, [4] uterine artery embolization in combination with dilatation and curettage, and [5] hysteroscopy.CONCLUSION(S): This review recommends treatment options for CSP in clinical practice, based on efficacy and safety. The literature supports an interventional rather than medical approach. Present recommendations are primarily based on case series. Multicenter, well-designed studies are needed to draw definite conclusions on how to treat CSP.

KW - Cesarean Section

KW - Cicatrix

KW - Female

KW - Humans

KW - Pregnancy

KW - Pregnancy, Ectopic

KW - Randomized Controlled Trials as Topic

KW - Journal Article

KW - Review

U2 - 10.1016/j.fertnstert.2015.12.130

DO - 10.1016/j.fertnstert.2015.12.130

M3 - Journal article

C2 - 26794422

VL - 105

SP - 958

EP - 967

JO - Sexuality, Reproduction and Menopause

JF - Sexuality, Reproduction and Menopause

SN - 1546-2501

IS - 4

ER -