Volume 33, Issue 157 (March & April 2025)                   J Adv Med Biomed Res 2025, 33(157): 4-4 | Back to browse issues page

XML Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Mendeley  
Zotero  
RefWorks
Barati M, Nikbakht R, Masihi S, Zamani M. Demographic and Clinical Determinants of Maternal Complications in Cesarean Scar Pregnancy Surgery: A Cross-Sectional Study in Southwestern Iran. J Adv Med Biomed Res 2025; 33 (157) :4-4
URL: http://journal.zums.ac.ir/article-1-7644-en.html
Demographic and Clinical Determinants of Maternal Complications in Cesarean Scar Pregnancy Surgery: A Cross-Sectional Study in Southwestern Iran
Mojgan Barati1 , Roshan Nikbakht1 , Sara Masihi1 , Marjan Zamani *2
1- Department of Obstetrics and Gynecology, School of Medicine, Fertility Infertility and Perinatology Research Center. Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
2- Department of Obstetrics and Gynecology, School of Medicine, Fertility Infertility and Perinatology Research Center. Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran , Marjanzamaniii3198@gmail.com
Abstract:   (82 Views)

Background and Aims: Given the critical importance of timely diagnosis and treatment of cesarean scar pregnancy (CSP) and the lack of comprehensive studies in this field, this study was conducted to investigate the relationship between maternal complications following CSP surgery and various demographic and clinical factors.
Methods: This cross-sectional study analyzed 350 patients who underwent surgical treatment for CSP at Imam Khomeini Hospital in Ahvaz, Iran, from 2014 to 2023. Demographic and clinical data were collected from medical records. Statistical analyses, including chi-square and t-tests, were performed to assess associations between gestational age, uterine scarring patterns, fetal status, and maternal complications such as blood transfusion, hypervascularity, curettage, laparotomy, hysterectomy, and bladder rupture.
Results: The mean gestational age at diagnosis was 49.58 ± 17.07 days. Intrauterine scarring was the most common (68.57%), and 64.29% of fetuses were deceased at diagnosis. Curettage was the primary intervention (84.29%). Higher gestational age was significantly associated with increased need for packed cell transfusion (p<0.001), hypervascularity (p=0.007), and laparotomy (p<0.001). Uterine scarring patterns were significantly associated with packed cell transfusion, hypervascularity, curettage, and laparotomy (p<0.001). Fetal status significantly influenced rates of curettage (p=0.01) and laparotomy (p=0.02). There were no cases of disseminated intravascular coagulation or maternal death.
Conclusion: Gestational age, uterine scarring patterns, and fetal status are significant factors associated with maternal complications in CSP surgery. Early diagnosis and intervention may reduce the risk of severe complications.

Keywords: Cesarean Section, Postoperative Complications, Gestational Age, Risk Factors
     
Type of Study: Original Research Article | Subject: Medical Biology
Received: 2025/01/12 | Accepted: 2025/04/22 | Published: 2025/05/29
References
1. Hameed MSS, Wright A, Chern BSM. Cesarean scar pregnancy: current understanding and treatment including role of minimally invasive surgical techniques. Gynecol Minim Invasive Ther. 2023;12(2):64-71. [DOI:10.4103/gmit.gmit_116_22] [PMID] [PMCID]
2. Asif S, Aijawi S, Agten AK. Caesarean scar pregnancy: Diagnosis and management. Obstet Gynaecol Reprod Med. 2021;31(10):271-4. [DOI:10.1016/j.ogrm.2021.08.001]
3. Wu J, Ye J, OuYang Z, Wan Z, Zhang Q, Zhong B, et al. Outcomes of reproduction following cesarean scar pregnancy treatment: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2021;262:80-92. [DOI:10.1016/j.ejogrb.2021.05.010] [PMID]
4. Hanáček J, Heřman H, Brandejsová A, Eminger M, Křepelka P, Velebil P, et al. Cesarean scar pregnancy-a retrospective analysis of cases in the years 2012-2021. Ces Gynekol. 2022;87(4):245-8. [DOI:10.48095/cccg2022245] [PMID]
5. Zhang H, Huang J, Wu X, Fan H, Li H, Gao T. Clinical classification and treatment of cesarean scar pregnancy. Arch Gynecol Obstet. 2017;43(4):653-61. [DOI:10.1111/jog.13267] [PMID]
6. Glenn TL, Bembry J, Findley AD, Yaklic JL, Bhagavath B, Gagneux P, et al. Cesarean scar ectopic pregnancy: current management strategies. Obstet Gynecol Surv. 2018;73(5):293-302. [DOI:10.1097/OGX.0000000000000561] [PMID]
7. Jiao L-z, Zhao J, Wan X-r, Liu X-y, Feng F-z, Ren T, et al. Diagnosis and treatment of cesarean scar pregnancy. Chin Med Sci J. 2008;23(1):10-5. [DOI:10.1016/S1001-9294(09)60002-X] [PMID]
8. Silva B, Pinto PV, Costa MA. Cesarean Scar Pregnancy: A systematic review on expectant management. Eur J Obstet Gynecol Reprod Biol. 2023;288:36-43. [DOI:10.1016/j.ejogrb.2023.06.030] [PMID]
9. Timor-Tritsch IE, Khatib N, Monteagudo A, Ramos J, Berg R, Kovács S. Cesarean scar pregnancies: experience of 60 cases. J Ultrasound Med. 2015;34(4):601-10. [DOI:10.7863/ultra.34.4.601] [PMID]
10. Jalili J, Afiat M, Tara F, Khorsand N, Javidi A. Cesarean scar pregnancy and Successful treatment: Case series. Iran J Obstet Gynecol Infertil. 2017;20(5):97-102.
11. Tritsch I, Monteagudo A. Unforeseen consequences of the increasing rate of caesarean delieveries: placenta accreta and caesarean scar pregnancy-a review. Am J Obstet Gynecol. 2012;207:14-29. [DOI:10.1016/j.ajog.2012.03.007] [PMID]
12. Jayaram P, Okunoye G, Al Ibrahim AA, Ghani R, Kalache K. Expectant management of caesarean scar ectopic pregnancy: a systematic review. J Perinat Med. 2018;46(4):365-72. [DOI:10.1515/jpm-2017-0189] [PMID]
13. Timor-Tritsch IE, Monteagudo A, Calì G, D'Antonio F, Agten AK. Cesarean scar pregnancy: diagnosis and pathogenesis. Obstet Gynaecol Clin. 2019;46(4):797-811. [DOI:10.1016/j.ogc.2019.07.009] [PMID]
14. Xu X, Li D, Yang L, Jing X, Kong X, Chen D, et al. Surgical outcomes of cesarean scar pregnancy: an 8-year experience at a single institution. Arch Gynecol Obstet. 2021;303:1223-33. [DOI:10.1007/s00404-020-05906-7] [PMID]
15. Calì G, Timor‐Tritsch I, Palacios‐Jaraquemada J, Monteaugudo A, Buca D, Forlani F, et al. Outcome of Cesarean scar pregnancy managed expectantly: systematic review and meta‐analysis. Ultrasound Obstet Gynecol. 2018;51(2):169-75. [DOI:10.1002/uog.17568] [PMID]
16. Timor-Tritsch I, Buca D, Di Mascio D, Cali G, D'Amico A, Monteagudo A, et al. Outcome of cesarean scar pregnancy according to gestational age at diagnosis: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2021;258:53-9. [DOI:10.1016/j.ejogrb.2020.11.036] [PMID]
17. De Braud LV, Knez J, Mavrelos D, Thanatsis N, Jauniaux E, Jurkovic D. Risk prediction of major haemorrhage with surgical treatment of live cesarean scar pregnancies. Eur J Obstet Gynecol Reprod Biol. 2021;264:224-31. [DOI:10.1016/j.ejogrb.2021.07.030] [PMID]
18. Calì G, Timor‐Trisch IE, Palacios‐Jaraquemada J, Monteaugudo A, Forlani F, Minneci G, et al. Changes in ultrasonography indicators of abnormally invasive placenta during pregnancy. Int J Gynecol Obstet. 2018;140(3):319-25. [DOI:10.1002/ijgo.12413] [PMID]
19. Timor-Tritsch IE, Monteagudo A, Calì G, D'Antonio F, Agten AK. Cesarean Scar Pregnancy: Patient Counseling and Management. Obstet Gynecol Clin North Am. 2019;46(4):813-28. https://doi.org/10.1016/j.ogc.2019.07.010 [DOI:10.1016/j.ogc.2019.07.009] [PMID]
20. Tanaka K, Coghill E, Ballard E, Sekar R, Amoako A, Khalil A, et al. Management of caesarean scar pregnancy with high dose intravenous methotrexate infusion therapy: 10-year experience at a single tertiary centre. Eur J Obstet Gynecol Reprod Biol. 2019;237:28-32. [DOI:10.1016/j.ejogrb.2019.04.008] [PMID]
Send email to the article author

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.