Cesarean Scar Ectopic Pregnancy Clinical Classification System With Recommended Surgical Strategy

作者：Yanli Ban, Jia Shen, Xia Wang, Teng Zhang, Xuxu Lu, Wenjie Qu, Yiping Hao, Zhonghao Mao, Shizhen Li, Guowei Tao, Fang Wang, Ying Zhao, Xiaolei Zhang, Yuan Zhang, Guiyu Zhang, Baoxia Cui · 发表于：Obstetrics and Gynecology · 年份：2023 · DOI：10.1097/aog.0000000000005113 · 被引用次数：76 · 研究领域：Ectopic Pregnancy Diagnosis and Management、Appendicitis Diagnosis and Management、Gynecological conditions and treatments

OBJECTIVE: To establish a new cesarean scar ectopic pregnancy clinical classification system with recommended individual surgical strategy and to evaluate its clinical efficacy in treatment of cesarean scar ectopic pregnancy. METHODS: This retrospective cohort study included patients with cesarean scar ectopic pregnancy in Qilu Hospital in Shandong, China. From 2008 to 2015, patients with cesarean scar ectopic pregnancy were included to determine risk factors for intraoperative hemorrhage during cesarean scar ectopic pregnancy treatment. Univariable analysis and multivariable logistic regression analyses were used to explore the independent risk factors for hemorrhage (300 mL or greater) during a cesarean scar ectopic pregnancy surgical procedure. The model was internally validated with a separate cohort. Receiver operating characteristic curve methodology was used to identify optimal thresholds for the identified risk factors to further classify cesarean scar ectopic pregnancy risk, and the recommended operative treatment was established for each classification group by expert consensus. A final cohort of patients from 2014 to 2022 were classified according to the new classification system, and the recommended surgical procedure and clinical outcomes were abstracted from the medical record. RESULTS: Overall, 955 patients with first-trimester cesarean scar ectopic pregnancy were included; 273 were used to develop a model to predict intraoperative hemorrhage with cesarean scar...