Risk factors for intraoperative hemorrhage at evacuation of a cesarean scar pregnancy following uterine artery embolization

Objective: To determine risk factors associated with massive uterine bleeding during dilation and suction curettage (D&C) after uterine artery embolization (UAE) for the treatment of cesarean scar pregnancy (CSP). Methods: Data from 128 CSP patients treated with D&C after UAE were analyzed to assess risk factors associated with massive uterine bleeding (blood loss 500 mL or more) during D&C after UAE. Results: In total, 15 CSP patients had massive bleeding during D&C after UAE. Univariate analysis showed that a greater gestational age (GA), a larger CSP mass size, a thinner myometrium at the implantation site, a GA of 8 weeks or more, a CSP mass diameter of 6 cm or more, and evidence of fetal heartbeat were risk factors for massive bleeding (P < 0.05). In a binary logistic regression analysis, GA of 8 weeks or more and CSP mass diameter of 6 cm or more remained as the only significant risk factors for massive bleeding (OR 11.49 [95% CI 1.08-122.13] and OR 96.59 [95% CI 6.20-150.57], respectively; P < 0.05). Conclusion: For CSP masses with a GA of 8 weeks or more and a diameter of 6 cm or more, the outcome of surgical evacuation after UAE tends to be unsatisfactory. (C) 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.