Risk prediction of major hemorrhage with surgical treatment
Surgery for cesarean scar pregnancies can be complicated by heavy bleeding. The risk of heavy bleeding is low at ≤ 8weeks’ gestation. Gestational age of ≥ 9 weeks and placental lacunae are associated with major blood loss.

The study evaluates the association between demographic and ultrasound variables and major intra-operative blood loss during the surgical transcervical evacuation of live cesarean scar pregnancies.

Researchers included all women diagnosed with a live cesarean scar ectopic pregnancy who chose to have surgical management in the study center. A preoperative ultrasound was performed on each patient. All women underwent transcervical suction curettage under ultrasound guidance. The primary outcome was the rate of postoperative blood transfusion. The secondary outcomes were estimated intra-operative blood loss, rate of retained products of conception, need for repeat surgery, need for uterine artery embolization, and hysterectomy rate. 80 women were diagnosed with a live cesarean scar pregnancy, of whom 62 (78%) opted for surgical management.

- The median crown-rump length was 9.3mm. Median blood loss at the time of surgery was 100ml, and six women required blood transfusion.

- Crown-rump length and presence of placental lacunae were significant predictive factors for the need for blood transfusion and blood loss >500ml at univariate analysis; on multivariate analysis, only crown-rump length was a significant predictor for the need for blood transfusion.

- Blood transfusion was required in 6/18 cases with the crown-rump length ≥of 23 mm but in none of 44 women presenting with a crown-rump length <23mm.

The risk of severe intraoperative bleeding and the need for blood transfusion during or after surgical evacuation of live cesarean scar pregnancies increases with gestational age and is higher in the presence of placental lacunae.

European Journal of Obstetrics & Gynecology and Reproductive Biology
Source: https://doi.org/10.1016/j.ejogrb.2021.07.030