Outcomes of subsequent pregnancies in patients following treatment of cesarean scar pregnancy with high intensity focused ultrasound followed by ultrasound-guided dilation and curettage

Figures & data

Table 1. Demographic characteristics of CSP patients with reproductive requirement underwent HIFU followed by USg-D&C (n = 28).

Variables	Value
Age (y)	31.18 ± 4.88
BMI (kg/m^2)	21.53 ± 2.48
Symptoms (n)
Asymptomatic	8
Abdominal pain	2
Painless vaginal bleeding	14
Vaginal bleeding and abdominal pain	4
Days of amenorrhea (d)	44 (41, 48)
Pre-treatment serum β-hCG (mIU/mL)	19638.20 (8170.80, 37978.80)
Previous cesarean sections (n)
1	21
2	6
3	1
Interval from last CS (y)	4.79 ± 3.93
Largest diameter of gestational sac (mm)	28.69 ± 9.51
Types of CSP
Type I	19
Type II	9
Thickness of gestational sac embedding myometrium (mm)	4.50 ± 1.43

Figure 1. A sagittal view magnetic resonance imaging showed a gestational sac embedding at a previous cesarean section scar (red arrow).

Figure 2. Real-time monitoring ultrasound and contrast enhanced ultrasound images obtained from a patient with CSP before and after HIFU. (A) Pre-HIFU ultrasound image showed a gestational sac (red arrow) embedding in the CSP scar; (B) Real-time ultrasound image showed the significant gray scale change (red arrow) in the embedding area of the CSP scar immediately after HIFU treatment; (C) Pre-HIFU contrast-enhanced ultrasound showed enhancement in myometrium of CSP scar (red arrow) around gestational sac; (D) Post-HIFU contrast-enhanced ultrasound showed no enhancement in myometrium of CSP scar (red arrow).

Table 2. Treatment and follow-up outcomes of CSP patients with reproductive requirement underwent HIFU followed by USg-D&C (n = 28).

Variables	Value
Treatment power (w)	396.50 (375.50, 400.00)
Treatment time (min)	76.93 ± 36.81
Sonication time (s)	616.04 ± 369.82
Treatment intensity (s/h)	466.12 ± 110.98
Blood loss during curettage (ml)	24.72 ± 19.13
Duration of vaginal bleeding post-curettage (d)	7.65 ± 6.96
Serum β-hCG 1 week post-curettage (mIU/mL)	2264.30 (1358.30, 5752.35)
Time for serum β-hCG return to normal level (d)	31.96 ± 19.38

Table 3. Pregnancy outcomes of CSP patients after HIFU and USg-D&C (n = 23).

Pregnancy outcomes	Cases
Intrauterine pregnancy	18
Full-term birth	12
On-going pregnancy	1
Induced abortion	5
Tubal pregnancy	3
Recurrent CSP	2

Table 4. Delivery outcomes of CSP patients with intrauterine pregnancy after HIFU and USg-D&C (n = 12).

Variables	Value
Interval between conception and HIFU treatment (m)	18.38 ± 10.04
Gestational age (wk)	38.25 ± 0.75
Blood loss during CS (ml)	97.50 ± 29.89
Outcome of newborn
Sex (Male/Female)	6/6
Birth weight (g)	3225.00 ± 235.00
Apgar score in 1 min	10
Apgar score in 5 min	10
Complication during pregnancy/intrapartum/postpartum
Intrahepatic cholestasis of pregnancy	2
Mild anemia during pregnancy	1

Figure 3. Flow chart of subsequent pregnancy outcomes of CSP patients treated with USgHIFU and USg-D&C.