Cheng XL, Cao XY, Wang XQ, Lin HL, Fang JC, Wang L. Diagnosing early scar pregnancy in the lower uterine segment after cesarean section by intracavitary ultrasound. World J Clin Cases 2022; 10(2): 547-553 [PMID: 35097080 DOI: 10.12998/wjcc.v10.i2.547]
Corresponding Author of This Article
Lin Wang, BM BCh, Chief Doctor, Department of Ultrasonography, Women and Children Health Institute Futian Shenzhen, No. 1019 Jintian Road, Futian District, Shenzhen 518026, Guangdong Province, China. wlszftfy@163.com
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jan 14, 2022; 10(2): 547-553 Published online Jan 14, 2022. doi: 10.12998/wjcc.v10.i2.547
Diagnosing early scar pregnancy in the lower uterine segment after cesarean section by intracavitary ultrasound
Xiao-Ling Cheng, Xiao-Yan Cao, Xiao-Qian Wang, Heng-Li Lin, Jin-Chuan Fang, Lin Wang
Xiao-Ling Cheng, Xiao-Yan Cao, Xiao-Qian Wang, Heng-Li Lin, Jin-Chuan Fang, Lin Wang, Department of Ultrasonography, Women and Children Health Institute Futian Shenzhen, Shenzhen 518026, Guangdong Province, China
Author contributions: Cheng XL and Cao XY design the experiment; Wang XQ drafted the work, Lin HL and Fang JC collected the data; Wang L and Cheng XL analysed and interpreted data, Cao XY and Wang XQ wrote the manuscript; all authors read and proofed the revised manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of Women and Children Health Institute Futian Shenzhen.
Informed consent statement: Informed consents were obtained from all patients and their families.
Conflict-of-interest statement: The authors declared that there is no conflict of interest among them.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement - checklist of items, and the manuscript was prepared and revised according to the STROBE Statement- checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lin Wang, BM BCh, Chief Doctor, Department of Ultrasonography, Women and Children Health Institute Futian Shenzhen, No. 1019 Jintian Road, Futian District, Shenzhen 518026, Guangdong Province, China. wlszftfy@163.com
Received: August 26, 2021 Peer-review started: August 26, 2021 First decision: September 29, 2021 Revised: October 14, 2021 Accepted: November 28, 2021 Article in press: November 28, 2021 Published online: January 14, 2022
Abstract
BACKGROUND
Early scar pregnancy (CSP) in the lower uterine segment after cesarean section is a type of ectopic pregnancy that can cause major complications if left untreated. Transabdominal ultrasound is a common procedure but is influenced by external factors. Thus, intracavitary ultrasound may have better diagnostic efficiency for CSP.
AIM
To assess the value of intracavitary ultrasound for diagnosing CSP in the lower uterine segment after cesarean section.
METHODS
Patients diagnosed with CSP in our hospital from October 2019 to April 2021 were recruited. Transabdominal and intracavitary ultrasound examinations were performed to compare the diagnostic differences for CSP and its types.
RESULTS
Sixty-three patients were diagnosed during the study period. The diagnostic accuracy for CSP was higher in intracavitary ultrasound (96.83%) than in transabdominal ultrasound (84.13%) (P < 0.05). The missed diagnosis and misdiagnosis rates did not differ among the ultrasound types (intra: 0.00% and 3.17%; trans: 4.76% and 11.11%, respectively; P > 0.05). For the diagnostic rates for the CSP types, the rates for gestational sac (100.00% vs 90.48%), heterogeneous mass (93.75% vs 75.00%), and part of the uterine cavity (80.00% vs 60.00%) were higher in intracavitary ultrasound than in transabdominal ultrasound, but the difference was not statistically significant (P > 0.05). For gestational sac CSP patients, intracavitary ultrasound showed that the gestational sac was located in the lower uterine segment scar with abundant peripheral blood flow; the distance between the gestational sac and the serosal layer was 2.42 ± 0.50 cm. Intracavitary ultrasound for heterogeneous mass CSP patients indicated that the mass mainly occurred in the lower anterior uterine wall, protruding into the bladder, and was surrounded by abundant internal and peripheral blood flow; the distance between the mass and serosal layer was 1.79 ± 0.30 cm. For CSP type partly located in the uterine cavity, the gestational sac was partly located in the lower uterine cavity and partly in the scar with abundant internal and peripheral blood flow; the distance between the gestational sac and the serosal layer was 2.29 ± 0.28 cm.
CONCLUSION
Intracavitary ultrasound had a higher diagnostic accuracy and application value for diagnosing CSP than transabdominal ultrasound, with reduced risk of missed diagnoses and misdiagnosis, thereby preventing delayed treatment.
Core Tip: This study assessed the value of using intracavitary ultrasound for diagnosing early scar pregnancy after cesarean section and found that it had higher diagnostic accuracy than traditional transabdominal ultrasound, reducing the risk of missed diagnosis and misdiagnosis, likely resulting in prompt treatment and improved patient prognosis.
