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• W3043257046 abstract "Sir, We read the paper by Morlando et al1 regarding reproductive outcome after cesarean scar pregnancy (CSP) with great interest. The study had two main conclusions. First, women with a prior CSP are at high risk of recurrence, miscarriage, preterm birth and placenta accreta spectrum. Second, there is still insufficient evidence to elucidate whether the type of management adopted (surgical vs non-surgical) can impact reproductive outcome after CSP. We agree with the first, but believe that the second conclusion is debatable. Although the pathogenesis of CSP is still unclear, the mechanism has been postulated to involve blastocyst implantation within a microscopic dehiscence tract in the scar of a prior cesarean section.2 Therefore, the resection and repair of cesarean scar could reduce the recurrence of CSP theoretically.3 However, the systematic review found that the recurrence of CSP in the surgically treated group was higher than that in the non-surgically treated group (21% vs 15.2%).1 We think that the possible reason for this contradiction is the wrong stratification of CSP treatment methods. The authors of the systematic review divided the types of management into a surgical group and a non-surgical group. The surgical group included uterine curettage, hysteroscopic, laparotomic or laparoscopic resection, whereas the non-surgical group included systematic or local administration of methotrexate, needle aspiration, high intensity focused ultrasound, Foley or Cook's catheter insertion or uterine artery embolization (UAE). Obviously, uterine curettage and hysteroscopy in the surgical group did not resect and repair the cesarean scar. Furthermore, UAE alone is rarely used to treat CSP, and it is often combined with uterine curettage or hysteroscopy. Therefore, this classification is unreasonable. In fact, there are dozens of methods for CSP treatment and there is no universally recognized classification.3 As how cesarean scar is managed may affect subsequent reproductive outcome, we believe that the CSP management could be divided into three categories4: (a) conservative treatment, including systemic or local methotrexate injection, which basically has no obvious effect on cesarean scar, (b) surgical treatment without repair of cesarean scar, such as uterine curettage, hysteroscopy or UAE and (c) surgical treatment with resection and repair of cesarean scar, including transabdominal, laparoscopic and transvaginal hysterotomy. If such a classification is adopted, the effect of the treatment method on the subsequent pregnancy after CSP can be more appropriately studied. This work was supported by a grant from the Medical Science and Technology Research Fund of Guangdong (NO. A2020244)." @default.
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• W3043257046 date "2020-07-29" @default.
• W3043257046 modified "2023-09-26" @default.
• W3043257046 title "The effect of previous treatment on reproductive outcome after cesarean scar pregnancy needs to be reevaluated" @default.
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• W3043257046 doi "https://doi.org/10.1111/aogs.13960" @default.
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