Reproductive Outcomes Following High-Intensity Focused Ultrasound Treatment for Cesarean Scar Pregnancy

Le résumé fourni par la source

Richao Liang,1,2 Wenwei Pan,1,2 Guizhen Lyu,3 Ming Chen,1,2 Li Wen,1,2 Tingting Chen,1,2 Yikang Wang,1,2 Rongju Liu4 1Department of Obstetrics and Gynecology, Dongguan Maternal and Child Health Care Hospital, Dongguan, Guangdong Province, People’s Republic of China; 2Dongguan Key Laboratory of Female Reproductive Health, Dongguan, Guangdong Province, People’s Republic of China; 3Dongguan Labway Clinical Laboratory Co., Ltd, Dongguan, Guangdong Province, People’s Republic of China; 4Reproductive Medical Center, Dongguan Songshan Lake Central Hospital Affiliated with Guangdong Medical University, Dongguan, Guangdong Province, People’s Republic of ChinaCorrespondence: Rongju Liu, Reproductive Medical Center, Dongguan Songshan Lake Central Hospital Affiliated with Guangdong Medical University, Dongguan, Guangdong Province, People’s Republic of China, Tel +86 13729276049, Email donglibaiju@126.comObjective: Cesarean scar pregnancy (CSP) is a rare but potentially life-threatening form of ectopic pregnancy associated with uterine rupture and severe hemorrhage. Optimizing fertility-preserving treatment strategies remains a critical clinical challenge. To investigate the reproductive outcomes and associated risk factors in patients with CSP after conservative surgery utilizing High-Intensity Focused Ultrasound (HIFU).Methods: In this retrospective cohort study (July 2017-June 2020), 337 CSP patients were stratified into HIFU group (n=210) or the non-HIFU group (n=127). Multivariate logistic regression identified predictors of re-pregnancy and recurrent cesarean scar pregnancy (RCSP).Results: The re-pregnancy rate was significantly higher in the HIFU group (61.9%, 130/210) than in the non-HIFU group (38.6%, 49/127) (P< 0.001). Multivariate analysis identified HIFU treatment (OR=2.728, P< 0.0001) and an interval > 3 years since the last cesarean section (OR=5.497, P=0.039) as significant predictors of higher re-pregnancy rates. Conversely, advanced age (OR=0.923/year, P=0.003), > 3 cesarean sections (OR=0.255, P=0.037), and > 3 induced abortions (OR=0.245, P=0.008) were associated with lower rates. Among the 179 patients who achieved pregnancy, RCSP incidence was significantly lower in the HIFU group (21.5%, 28/130) than in the non-HIFU group (42.9%, 21/49) (P=0.004). Multivariate analysis showed HIFU treatment reduced RCSP odds by 67.7% (OR=0.323, P=0.004), with thicker scars further lowering risk by 33.7% (OR=0.663/mm, P=0.021). Prior cesarean sections significantly increased RCSP risk (vs. 1 section: 2 sections OR=2.460, P=0.017; 3 sections OR=13.089, P=0.033; > 3 sections OR=11.288, P=0.049).Conclusion: Conservative surgery incorporating HIFU significantly improves re-pregnancy rates and reduces RCSP risk in CSP patients. Younger age, longer intervals since the last cesarean section, and fewer cesarean sections or abortions correlate with higher re-pregnancy rates. Thicker scar tissue and fewer cesarean sections are protective against RCSP. These findings warrant validation in larger prospective studies.Keywords: cesarean scar pregnancy, high-intensity focused ultrasound, recurrent cesarean scar pregnancy, reproductive outcomes, risk factors

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.