Validation of a 10-Point Scoring System for Treatment of Cesarean Scar Pregnancy

Figures & data

Table 1 10-Point Scoring System for Assessing the Severity of Cesarean Scar Pregnancy^a

Characteristic	Classification	Score
Remnant myometrial thickness	>3	0
	1–3	0.54
	<1	2.92
Grading of color Doppler signal	I	0
	II	0.21
	III	3.01
Location of gestational sac	Superficial	0
	Partial	0.13
	Complete	0.52
Number of cesarean sections	1	0
	2	0.11
	3	0.23
Fetal heartbeat	Negative	0
	Positive	1.23
Diameter of gestational sac (mm)	≤25	0
	>25	2.1

Note: ^aAdapted with permission from Sun QL, Luo L, Gao CY, Yan P, Yang Y, Chen ZQ. Scoring system for the prediction of the successful treatment modality in women with cesarean scar pregnancy. Int J Gynaecol Obstet. 2019;146:1–7. © 2019 International Federation of Gynecology and Obstetric.⁹

Table 2 Clinical and Ultrasonographic Characteristics of Patients by Treatment Group

Characteristics	All Patients (n = 183)	Evacuation (n = 108)	UAE (n = 57)	LLR (n = 18)	P
Age (years)^a	32.7 ± 4.3	32.6 ± 4.0	33.0 ± 4.9	32.7 ± 4.6	0.924
Gravidity^a	4.7 ± 1.7	4.6 ± 1.4	4.7 ± 21.	5.1 ± 1.8	0.537
Gestational age (days)^a	44.9 ± 7.4	41.6 ± 5.1	49.2 ± 7.3	51.7 ± 7.9	0.000
Number of Previous Abortions^b
0	15 (8.2)	9 (8.3)	4 (7.0)	2 (11.1)	0.707
1	53 (29.0)	31 (29.7)	19 (33.3)	3 (16.7)
2	54 (29.5)	34 (31.5)	16 (28.1)	4 (22.2)
≥3	61 (33.3)	34 (31.5)	18 (31.6)	9 (50.0)
Number of Previous Cesarean Sections^b
1	103 (56.3)	52 (48.1)	40 (70.2)	10 (55.5)	0.042
2	78 (42.6)	55 (50.9)	16(28.1)	7 (38.9)
3	2 (1.1)	1 (1.0)	1 (1.7)	1 (5.6)
Maximal Diameter of Gestational Sac (mm)^b
≤25	88 (48.1)	71(65.7)	15 (26.3)	2 (11.1)	0.000
>25	95 (51.9)	37 (34.3)	42 (73.7)	16 (88.9)
Remnant Myometrial Thickness (mm)^b
<1	37 (20.2)	7 (6.5)	18 (31.6)	12 (66.7)	0.000
1–3	103 (56.3)	65 (60.2)	32 (56.1)	6 (33.3)
>3	43 (23.5)	36 (33.3)	7 (12.3)	0 (0)
Grading of Color Doppler Signals^b
I	39 (21.3)	38 (35.2)	1 (1.8)	0 (0)	0.000
II	82 (44.8)	62 (57.4)	17 (29.9)	3 (16.7)
III	62 (33.9)	8 (7.4)	39 (68.3)	15 (83.3)
Fetal Heartbeat^b
Positive	78 (42.6)	32 (29.6)	33 (57.9)	13 (72.2)	0.000
Negative	105 (57.4)	76 (70.4)	24 (42.1)	5 (27.8)
Location of Gestational Sac^b
Superficial	16 (8.7)	15 (13.9)	1 (1.8)	0 (0.0)	0.016
Partial	163 (89.1)	92 (85.2)	53 (92.9)	18 (100.0)
Complete	4 (2.2)	1 (0.9)	3 (5.3)	0 (0.0)
Time to Negative β-HCG (days)^a
	20 (15, 25)	20 (15, 25)	20 (18, 30)	25 (15, 31.25)	0.040
Time Until Resolution of Residue (days)^a
	23 (7, 40)	20 (7, 32.75)	25 (20, 47.5)	8.5 (7, 30.75)	0.003

Notes: ^aKruskal–Wallis test; ^bPearson Chi-square test. Values are given as mean ± SD, number (percentage), or median (interquartile range).

Abbreviations: UAE, uterine artery embolization; LLR, laparoscopic local resection; β-HCG, human chorionic gonadotrophin.

Figure 1 Patient flowchart.

Abbreviations: CSP, cesarean scar pregnancy; UAE, uterine artery embolization.

Table 3 Scores on the 10-Point Scoring System by Treatment Group

Score	All Patients	Evacuation	UAE	LLR
1	48	48 (100)	0	0
2	7	7 (100)	0	0
3	23	19 (82.6)	2 (8.7)	2 (8.7)
4	19	15 (78.9)	4 (21.1)	0
5	27	15 (55.6)	12 (44.4)	0
6	14	3 (21.4)	10 (71.4)	1 (7.2)
7	12	1 (8.3)	9 (75.0)	2 (16.7)
8	16	0	13 (81.3)	3 (18.7)
9	5	0	4 (80.0)	1 (20.0)
10	12	0	3 (25.0)	9 (75.0)
Total	183	108 (59.0)	57 (31.1)	18 (9.8)

Note: Values are given as number (row percentage).

Abbreviations: UAE, uterine artery embolization; LLR, laparoscopic local resection.

Table 4 Consistency Between Actual and Predicted Therapy

Predicted Therapy	Actual Therapy			Total	P	Contingency Coefficient	Kappa
	Evacuation	UAE	LLR
Evacuation	89 (91.8)	6 (6.2)	2 (2.0)	97	0.000	0.645	0.610
UAE	19 (27.5)	44 (63.8)	6 (8.7)	69
LLR	0	7 (41.2)	10 (58.8)	17
Total	108	57	18	183

Note: Values are given as number (row percentage).

Abbreviations: UAE, uterine artery embolization; LLR, laparoscopic local resection.

Figure 2 Receiver operating characteristic curve for any salvage treatment.

Figure 3 Receiver operating characteristic curve for laparoscopic surgery.

Sun QL, Luo L, Gao CY, Yan P, Yang Y, Chen ZQ. Scoring system for the prediction of the successful treatment modality in women with cesarean scar pregnancy. Int J Gynaecol Obstet. 2019;146:1–7. doi:10.1002/ijgo.12881

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