Caesarean scar pregnancy in the UK: a national cohort study

H. M. Harb; M. Knight; C. Bottomley; C. Overton; A. Tobias; I. D. Gallos; M. Shehmar; R. Farquharson; A. Horne; P. Latthe; E. Edi-Osagie; M. MacLean; E. Marston; J. Zamora; F. Dawood; R. Small; J. Ross; T. Bourne; A. Coomarasamy; D. Jurkovic

doi:10.1111/1471-0528.15255

Caesarean scar pregnancy in the UK: a national cohort study

H. M. Harb^*, M. Knight, C. Bottomley, C. Overton, A. Tobias, I. D. Gallos, M. Shehmar, R. Farquharson, A. Horne, P. Latthe, E. Edi-Osagie, M. MacLean, E. Marston, J. Zamora, F. Dawood, R. Small, J. Ross, T. Bourne, A. Coomarasamy, D. Jurkovic

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

46 Citations (Scopus)

Abstract

Objective: To estimate the incidence of caesarean scar pregnancy (CSP) and to describe the management outcomes associated with this condition. Design: A national cohort study using the UK Early Pregnancy Surveillance Service (UKEPSS). Setting: 86 participating Early Pregnancy Units. Population: All women diagnosed in the participating units with CSP between November 2013 and January 2015. Methods: Cohort study of women identified through the UKEPSS monthly mailing system. Main outcome measures: Incidence, clinical outcomes and complications. Results: 102 cases of CSP were reported, with an estimated incidence of 1.5 per 10 000 (95% CI 1.1–1.9) maternities. Full outcome data were available for 92 women. Management was expectant in 21/92 (23%), medical in 15/92 (16%) and surgical in 56/92 (61%). The success rates of expectant, medical and surgical management were 43% (9/21), 46% (7/15) and 96% (54/56), respectively. The complication rates were 15/21 (71%) with expectant, 9/15 (60%) with medical and 20/56 (36%) with surgical management. Discharge from care (median number of days) was 82 (range 37–174) with expectant, 21 (range 10–31) with medical and 11 (range 4–49) with surgical management. Conclusions: Surgical management appears to be associated with a high success rate, low complication rate and short post-treatment follow up. Tweetable abstract: Surgery for CSP appears to be successful, with low complication rates and short post-treatment follow up.

Original language	English
Pages (from-to)	1663-1670
Number of pages	8
Journal	BJOG: An International Journal of Obstetrics and Gynaecology
Volume	125
Issue number	13
DOIs	https://doi.org/10.1111/1471-0528.15255
Publication status	Published - 1 Dec 2018

Bibliographical note

Funding Information:
Funding was received from the Association of Early Pregnancy Units for administrative support this study. HH was funded by the Birmingham Women’s and Children’s Hospital R&D Springboard Fellowship.

Funding Information:
The primary outcome was successful treatment following primary management. Success was defined as complete resolution of pregnancy without the need for further intervention following primary management. For instance, if a woman had surgical treatment as the primary management approach and on follow up she was found to have persistent products of conception for which further surgery is performed, this was considered as an additional intervention and failure of primary management. We also recorded complication rates and length of post-treatment follow up. The study outcomes were set by the UKEPSS CSP study steering committee. The UKEPSS general methodology and this study were approved by the North Wales Research Ethics Committee (REC reference 13/WA/0318). Funding for this study was received from the Association of Early Pregnancy Units and Birmingham Women’s and Children’s Foundation NHS Trust R&D Springboard Fellowship.

Publisher Copyright:
© 2018 Royal College of Obstetricians and Gynaecologists

Keywords

Caesarean
caesarean scar pregnancy
cohort study
ectopic
placenta accreta

ASJC Scopus subject areas

Obstetrics and Gynaecology

Access to Document

10.1111/1471-0528.15255

Cite this

Harb, H. M., Knight, M., Bottomley, C., Overton, C., Tobias, A., Gallos, I. D., Shehmar, M., Farquharson, R., Horne, A., Latthe, P., Edi-Osagie, E., MacLean, M., Marston, E., Zamora, J., Dawood, F., Small, R., Ross, J., Bourne, T., Coomarasamy, A., & Jurkovic, D. (2018). Caesarean scar pregnancy in the UK: a national cohort study. BJOG: An International Journal of Obstetrics and Gynaecology, 125(13), 1663-1670. https://doi.org/10.1111/1471-0528.15255

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title = "Caesarean scar pregnancy in the UK: a national cohort study",

abstract = "Objective: To estimate the incidence of caesarean scar pregnancy (CSP) and to describe the management outcomes associated with this condition. Design: A national cohort study using the UK Early Pregnancy Surveillance Service (UKEPSS). Setting: 86 participating Early Pregnancy Units. Population: All women diagnosed in the participating units with CSP between November 2013 and January 2015. Methods: Cohort study of women identified through the UKEPSS monthly mailing system. Main outcome measures: Incidence, clinical outcomes and complications. Results: 102 cases of CSP were reported, with an estimated incidence of 1.5 per 10 000 (95% CI 1.1–1.9) maternities. Full outcome data were available for 92 women. Management was expectant in 21/92 (23%), medical in 15/92 (16%) and surgical in 56/92 (61%). The success rates of expectant, medical and surgical management were 43% (9/21), 46% (7/15) and 96% (54/56), respectively. The complication rates were 15/21 (71%) with expectant, 9/15 (60%) with medical and 20/56 (36%) with surgical management. Discharge from care (median number of days) was 82 (range 37–174) with expectant, 21 (range 10–31) with medical and 11 (range 4–49) with surgical management. Conclusions: Surgical management appears to be associated with a high success rate, low complication rate and short post-treatment follow up. Tweetable abstract: Surgery for CSP appears to be successful, with low complication rates and short post-treatment follow up.",

keywords = "Caesarean, caesarean scar pregnancy, cohort study, ectopic, placenta accreta",

author = "Harb, {H. M.} and M. Knight and C. Bottomley and C. Overton and A. Tobias and Gallos, {I. D.} and M. Shehmar and R. Farquharson and A. Horne and P. Latthe and E. Edi-Osagie and M. MacLean and E. Marston and J. Zamora and F. Dawood and R. Small and J. Ross and T. Bourne and A. Coomarasamy and D. Jurkovic",

note = "Funding Information: Funding was received from the Association of Early Pregnancy Units for administrative support this study. HH was funded by the Birmingham Women{\textquoteright}s and Children{\textquoteright}s Hospital R&D Springboard Fellowship. Funding Information: The primary outcome was successful treatment following primary management. Success was defined as complete resolution of pregnancy without the need for further intervention following primary management. For instance, if a woman had surgical treatment as the primary management approach and on follow up she was found to have persistent products of conception for which further surgery is performed, this was considered as an additional intervention and failure of primary management. We also recorded complication rates and length of post-treatment follow up. The study outcomes were set by the UKEPSS CSP study steering committee. The UKEPSS general methodology and this study were approved by the North Wales Research Ethics Committee (REC reference 13/WA/0318). Funding for this study was received from the Association of Early Pregnancy Units and Birmingham Women{\textquoteright}s and Children{\textquoteright}s Foundation NHS Trust R&D Springboard Fellowship. Publisher Copyright: {\textcopyright} 2018 Royal College of Obstetricians and Gynaecologists",

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Harb, HM, Knight, M, Bottomley, C, Overton, C, Tobias, A, Gallos, ID, Shehmar, M, Farquharson, R, Horne, A, Latthe, P, Edi-Osagie, E, MacLean, M, Marston, E, Zamora, J, Dawood, F, Small, R, Ross, J, Bourne, T, Coomarasamy, A & Jurkovic, D 2018, 'Caesarean scar pregnancy in the UK: a national cohort study', BJOG: An International Journal of Obstetrics and Gynaecology, vol. 125, no. 13, pp. 1663-1670. https://doi.org/10.1111/1471-0528.15255

TY - JOUR

T1 - Caesarean scar pregnancy in the UK

T2 - a national cohort study

AU - Harb, H. M.

AU - Knight, M.

AU - Bottomley, C.

AU - Overton, C.

AU - Tobias, A.

AU - Gallos, I. D.

AU - Shehmar, M.

AU - Farquharson, R.

AU - Horne, A.

AU - Latthe, P.

AU - Edi-Osagie, E.

AU - MacLean, M.

AU - Marston, E.

AU - Zamora, J.

AU - Dawood, F.

AU - Small, R.

AU - Ross, J.

AU - Bourne, T.

AU - Coomarasamy, A.

AU - Jurkovic, D.

N1 - Funding Information: Funding was received from the Association of Early Pregnancy Units for administrative support this study. HH was funded by the Birmingham Women’s and Children’s Hospital R&D Springboard Fellowship. Funding Information: The primary outcome was successful treatment following primary management. Success was defined as complete resolution of pregnancy without the need for further intervention following primary management. For instance, if a woman had surgical treatment as the primary management approach and on follow up she was found to have persistent products of conception for which further surgery is performed, this was considered as an additional intervention and failure of primary management. We also recorded complication rates and length of post-treatment follow up. The study outcomes were set by the UKEPSS CSP study steering committee. The UKEPSS general methodology and this study were approved by the North Wales Research Ethics Committee (REC reference 13/WA/0318). Funding for this study was received from the Association of Early Pregnancy Units and Birmingham Women’s and Children’s Foundation NHS Trust R&D Springboard Fellowship. Publisher Copyright: © 2018 Royal College of Obstetricians and Gynaecologists

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Objective: To estimate the incidence of caesarean scar pregnancy (CSP) and to describe the management outcomes associated with this condition. Design: A national cohort study using the UK Early Pregnancy Surveillance Service (UKEPSS). Setting: 86 participating Early Pregnancy Units. Population: All women diagnosed in the participating units with CSP between November 2013 and January 2015. Methods: Cohort study of women identified through the UKEPSS monthly mailing system. Main outcome measures: Incidence, clinical outcomes and complications. Results: 102 cases of CSP were reported, with an estimated incidence of 1.5 per 10 000 (95% CI 1.1–1.9) maternities. Full outcome data were available for 92 women. Management was expectant in 21/92 (23%), medical in 15/92 (16%) and surgical in 56/92 (61%). The success rates of expectant, medical and surgical management were 43% (9/21), 46% (7/15) and 96% (54/56), respectively. The complication rates were 15/21 (71%) with expectant, 9/15 (60%) with medical and 20/56 (36%) with surgical management. Discharge from care (median number of days) was 82 (range 37–174) with expectant, 21 (range 10–31) with medical and 11 (range 4–49) with surgical management. Conclusions: Surgical management appears to be associated with a high success rate, low complication rate and short post-treatment follow up. Tweetable abstract: Surgery for CSP appears to be successful, with low complication rates and short post-treatment follow up.

AB - Objective: To estimate the incidence of caesarean scar pregnancy (CSP) and to describe the management outcomes associated with this condition. Design: A national cohort study using the UK Early Pregnancy Surveillance Service (UKEPSS). Setting: 86 participating Early Pregnancy Units. Population: All women diagnosed in the participating units with CSP between November 2013 and January 2015. Methods: Cohort study of women identified through the UKEPSS monthly mailing system. Main outcome measures: Incidence, clinical outcomes and complications. Results: 102 cases of CSP were reported, with an estimated incidence of 1.5 per 10 000 (95% CI 1.1–1.9) maternities. Full outcome data were available for 92 women. Management was expectant in 21/92 (23%), medical in 15/92 (16%) and surgical in 56/92 (61%). The success rates of expectant, medical and surgical management were 43% (9/21), 46% (7/15) and 96% (54/56), respectively. The complication rates were 15/21 (71%) with expectant, 9/15 (60%) with medical and 20/56 (36%) with surgical management. Discharge from care (median number of days) was 82 (range 37–174) with expectant, 21 (range 10–31) with medical and 11 (range 4–49) with surgical management. Conclusions: Surgical management appears to be associated with a high success rate, low complication rate and short post-treatment follow up. Tweetable abstract: Surgery for CSP appears to be successful, with low complication rates and short post-treatment follow up.

KW - Caesarean

KW - caesarean scar pregnancy

KW - cohort study

KW - ectopic

KW - placenta accreta

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DO - 10.1111/1471-0528.15255

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SN - 1470-0328

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JO - BJOG: An International Journal of Obstetrics and Gynaecology

JF - BJOG: An International Journal of Obstetrics and Gynaecology

IS - 13

ER -

Caesarean scar pregnancy in the UK: a national cohort study

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

Access to Document

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