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Reproductive outcome after cesarean scar pregnancy: A systematic review and meta-analysis.

Morlando, M; Buca, D; Timor-Tritsch, I; Cali, G; Palacios-Jaraquemada, J; Monteagudo, A; Khalil, A; Cennamo, C; La Manna, V; Liberati, M; et al. Morlando, M; Buca, D; Timor-Tritsch, I; Cali, G; Palacios-Jaraquemada, J; Monteagudo, A; Khalil, A; Cennamo, C; La Manna, V; Liberati, M; D'Amico, A; Nappi, L; Colacurci, N; D'Antonio, F (2020) Reproductive outcome after cesarean scar pregnancy: A systematic review and meta-analysis. Acta Obstet Gynecol Scand, 99 (10). pp. 1278-1289. ISSN 1600-0412 https://doi.org/10.1111/aogs.13918
SGUL Authors: Khalil, Asma

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Abstract

INTRODUCTION: To evaluate subsequent reproductive among women with a prior cesarean scar pregnancy (CSP). MATERIAL AND METHODS: Medline, Embase and ClinicalTrials.gov databases were searched. Inclusion criteria were women with a prior CSP, defined as the gestational sac or trophoblast within the dehiscence/niche of the previous cesarean section scar or implanted on top of it. The primary outcome was the recurrence of CSP; secondary outcomes were the chance of achieving a pregnancy after CSP, miscarriage, preterm birth, uterine rupture and the occurrence of placenta accreta spectrum disorders. Sub-group analysis according to the management of CSP (surgical vs non- surgical) was also performed. Random effect meta-analyses of proportions were used to analyze the data. RESULTS: Forty-four studies (3598 women with CSP) were included. CSP recurred in 17.6% of women. Miscarriage, preterm birth and placenta accreta spectrum disorders complicated 19.1% (65/341), 10.3% (25/243) and 4.0% of pregnancies, while 67.0% were uncomplicated. When stratifying the analysis according to the type of management, CSP recurred in 21% of women undergoing surgical and in 15.2% of those undergoing non-surgical management, while placenta accreta spectrum disorders complicated 4.0% and 12.0% of cases respectively. CONCLUSIONS: Women with a prior CSP are at high risk of recurrence, miscarriage, preterm birth and placenta accreta spectrum. There is still insufficient evidence to elucidate whether the type of management adopted (surgical vs non-surgical) can impact reproductive outcome after CSP. Further large prospective studies sharing an objective protocol of prenatal management and long-term follow up are needed to establish the optimal management of CSP and to elucidate whether it may affect its risk of recurrence and pregnancy outcome in subsequent gestations.

Item Type: Article
Additional Information: This is the peer reviewed version of the following article: Morlando, M, Buca, D, Timor‐Tritsch, I, et al. Reproductive outcome after cesarean scar pregnancy: A systematic review and meta‐analysis. Acta Obstet Gynecol Scand. 2020; 99: 1278– 1289, which has been published in final form at https://doi.org/10.1111/aogs.13918. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Keywords: Cesarean scar pregnancy, placenta accreta spectrum, preterm birth, reproductive outcome, surgical treatment, uterine rupture, Obstetrics & Reproductive Medicine, 1114 Paediatrics and Reproductive Medicine, 1117 Public Health and Health Services
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Acta Obstet Gynecol Scand
ISSN: 1600-0412
Language: eng
Dates:
DateEvent
16 September 2020Published
19 June 2020Published Online
12 May 2020Accepted
Publisher License: Publisher's own licence
PubMed ID: 32419158
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/111969
Publisher's version: https://doi.org/10.1111/aogs.13918

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