PMID- 30092014
OWN - NLM
STAT- MEDLINE
DCOM- 20190213
LR  - 20190215
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 13
IP  - 8
DP  - 2018
TI  - New ultrasound grading system for cesarean scar pregnancy and its implications
      for management strategies: An observational cohort study.
PG  - e0202020
LID - 10.1371/journal.pone.0202020 [doi]
AB  - A cesarean section pregnancy (CSP) indicated the gestational sac (GS) implanted
      in the previous cesarean scar. The clinical manifestations of CSP present a wide 
      range of variations, and the optimal management is yet to be defined. We
      retrospectively enrolled 109 patients with the diagnosis of CSP from our
      department and categorized them into four grades based on the ultrasound
      presentation. Grade I CSP indicated the GS embedded in less than one-half
      thickness of the lower anterior corpus; and grade II CSP represented the GS
      extended to more than one-half thickness of overlying myometrium. Grade III CSP
      implied the GS bulged out of the cesarean scar; and grade IV CSP denoted that GS 
      became an amorphous tumor with rich vascularity at the cesarean scar.
      Seventy-eight women received surgery, and the complication rate was 14.1%
      (11/78). Linear regression analysis demonstrated a significant association
      between the invasiveness of the surgery and their ultrasound gradings. The
      mainstream operation for grade I CSP was transcervical resection, while the
      majority of grade III and IV patients required hysterotomy or hysterectomy.
      Another 31 women received chemotherapy with methotrexate as their initial
      treatment. The success rate for chemotherapy was 61.3%; the remaining patients
      required further surgery due to persistent CSP or heavy bleeding during or after 
      chemotherapy. Fifteen patients (48.3%) receiving chemotherapy suffered from
      complications (mostly bleeding). Among them, 7 (22.6%) patients experienced
      bleeding of more than 1,000 mL, and 9 (29.0%) of these 31 patients required blood
      transfusions. Our novel ultrasound grading system for CSP may help to communicate
      between physicians, and determine the optimal surgical strategy. Chemotherapy
      with methotrexate for CSP is not satisfactory and is associated with a higher
      rate of complications.
FAU - Lin, Shin-Yu
AU  - Lin SY
AUID- ORCID: 0000-0002-0753-2793
AD  - Department of Obstetrics and Gynecology, National Taiwan University Hospital and 
      National Taiwan University College of Medicine, Taipei, Taiwan.
FAU - Hsieh, Chia-Jung
AU  - Hsieh CJ
AD  - Department of Public Health, Tzu Chi University, Hualien, Taiwan.
FAU - Tu, Yi-An
AU  - Tu YA
AD  - Department of Obstetrics and Gynecology, National Taiwan University Hospital and 
      National Taiwan University College of Medicine, Taipei, Taiwan.
FAU - Li, Yi-Ping
AU  - Li YP
AUID- ORCID: 0000-0002-1144-2117
AD  - Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital,
      Taipei, Taiwan.
FAU - Lee, Chien-Nan
AU  - Lee CN
AD  - Department of Obstetrics and Gynecology, National Taiwan University Hospital and 
      National Taiwan University College of Medicine, Taipei, Taiwan.
FAU - Hsu, Wen-Wei
AU  - Hsu WW
AD  - Department of Obstetrics and Gynecology, National Taiwan University Hospital and 
      National Taiwan University College of Medicine, Taipei, Taiwan.
FAU - Shih, Jin-Chung
AU  - Shih JC
AD  - Department of Obstetrics and Gynecology, National Taiwan University Hospital and 
      National Taiwan University College of Medicine, Taipei, Taiwan.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20180809
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Abortifacient Agents, Nonsteroidal)
RN  - YL5FZ2Y5U1 (Methotrexate)
SB  - IM
MH  - Abortifacient Agents, Nonsteroidal/therapeutic use
MH  - Adult
MH  - Blood Transfusion
MH  - Cesarean Section/*adverse effects
MH  - Cicatrix/*diagnostic imaging/etiology
MH  - Decision Support Systems, Clinical
MH  - Female
MH  - Humans
MH  - Methotrexate/therapeutic use
MH  - Pregnancy
MH  - Pregnancy, Ectopic/*diagnostic imaging/drug therapy/surgery
MH  - Regression Analysis
MH  - Retrospective Studies
MH  - Severity of Illness Index
MH  - Ultrasonography/*methods
MH  - Uterine Hemorrhage/etiology
PMC - PMC6084953
COIS- The authors have declared that no competing interests exist.
EDAT- 2018/08/10 06:00
MHDA- 2019/02/14 06:00
CRDT- 2018/08/10 06:00
PHST- 2018/02/27 00:00 [received]
PHST- 2018/07/26 00:00 [accepted]
PHST- 2018/08/10 06:00 [entrez]
PHST- 2018/08/10 06:00 [pubmed]
PHST- 2019/02/14 06:00 [medline]
AID - 10.1371/journal.pone.0202020 [doi]
AID - PONE-D-18-06252 [pii]
PST - epublish
SO  - PLoS One. 2018 Aug 9;13(8):e0202020. doi: 10.1371/journal.pone.0202020.
      eCollection 2018.