Is suction curettage an effective treatment alternative for
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Suction curettage may be considered as first-line therapy for cesarean scar pregnancy, and in patients complicated with hemorrhage foley balloon tamponade can be used easily. Thinner myometrium at previous cesarean scar can be considered as a risk factor for failure of suction curettage in patients with cesarean scar pregnancy. The study aims to evaluate the success rate of suction curettage as a first-line treatment with or without the use of foley balloon tamponade for cesarean scar pregnancy and to determine the risk factors for failure of treatment.

The study was retrospective and included 36 cesarean scar pregnancy cases that underwent suction curettage for treatment. The presence of pain with active bleeding and more than 10 weeks of gestation were taken as the exclusion criterion. The procedure was performed under sonographic guidance. After the procedure, in patients who had a hemorrhage foley catheter was inserted into the uterine cavity. suction curettage failure was defined as a requirement of secondary intervention. Cesarean scar pregnancy types, myometrial thickness in the scar area, fetal cardiac activity, initial Beta human chorionic gonadotropin levels (?-HCG), history of vaginal delivery were compared between successful and failed groups.

Of 36 patients, 31 had favorable results with suction curettage?±?foley balloon tamponade. The success rate was found to be 86% (31/36) as first-line therapy. Foley catheter was applied for 23 patients, among them, four were in the failed group and 19 were in the favorable group. In the failed group, two patients had emergent laparotomy, two had repeat suction curettage the day after the initial treatment and one patient was treated with systemic MTX. Fetal cardiac activity and the presence of an embryonic pole were not different between the groups. Myometrial thickness in the failed group was less than the successful group, this difference was significant. cesarean scar pregnancy types, initial Beta human chorionic gonadotropin levels, and history of vaginal delivery were not different between the groups.

Source:https://www.ejog.org/article/S0301-2115(21)00002-6/fulltext?rss=yes
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