Cesarean section diverticulum area predicting the intraoperative hemorrhage at suction curettage for cesarean scar pregnancy after focused ultrasound ablation surgery

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Objectives To investigate the significance of the cesarean section diverticulum (CSD) area for predicting the intraoperative massive hemorrhage during suction curettage for cesarean scar pregnancy (CSP) after focused ultrasound ablation surgery (FUAS).Methods Data from 90 patients undergoing suction curettage after FUAS were collected. According to their intraoperative bleeding volume, patients were categorized into three groups: Group 1 (n = 71, <200 mL), Group 2 (n = 9, 200–300 mL) and Group 3 (n = 10, ≥300 mL). Multiple liner regression analysis was performed to identify the influencing factors for CSD area and intraoperative blood loss. The ROC curve was plotted to identify the optimal cutoff values.Results The median CSD area size in Group 3 (336.8 mm2) was significantly greater than in Groups 1 (128.6 mm2) and 2 (121.6 mm2) (p < .05). Using multiple linear regression analysis, CSD area was associated with intraoperative blood loss (p < .05). The optimal cutoff CSD areas for predicting intraoperative massive hemorrhage volumes ≥ 200 mL and ≥ 300 mL were 202.05 mm2 and 241.90 mm2, respectively. The mean gestational sac diameter and preoperative symptoms (+) were positively related to CSD area, while residual myometrial thickness was negatively correlated with the CSD area. CSD area showed the greatest relationship to sonication time (rs = 0.42), treatment time (rs = 0.316) and total energy used for ablation (rs = 0.415).Conclusion The preoperative CSD area could predict intraoperative massive hemorrhage during suction curettage after FUAS, which might inform therapy strategies for CSP patients.

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