Validation of a 10-Point Scoring System for Treatment of Cesarean Scar Pregnancy

Ting-Ting Tan, Qiu-Lei Sun, Li Luo, Zhu Chen, Xi Xiong, Jin-Hong Xiang, Ping Yan, Chun-Yan Gao, Zheng-Qiong Chen Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, People’s Republic of ChinaCorrespondence: Zheng-Qiong ChenDepartment of Obstetrics and Gynecology, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, People’s Republic of ChinaTel +86-23-6877-4012Email chenzhengqiong75@163.comPurpose: To validate a 10-point scoring system for the prediction of successful treatment modality in patients with cesarean scar pregnancy (CSP).Patients and Methods: Data were collected from women seen between April 1, 2018, and June 30, 2019, at the Second Affiliated Hospital of Army Medical University of China who were diagnosed with CSP and underwent evacuation, followed by uterine artery embolization (UAE) and successive laparoscopic local resection as salvage treatment if necessary. A score was computed based on clinical and ultrasonographic parameters included in a previously developed scoring system. Treatment indicated by the scoring system was compared with actual treatment received. Receiver operating characteristic (ROC) curves were used to identify cut-off scores for salvage treatment.Results: Of 183 women, 108 were successfully treated by evacuation, 57 required UAE, and 18 eventually underwent laparoscopic surgery. Among 97 women scoring 0– 4, 89 (91.8%) were treated by evacuation only. Of 69 women scoring between 5 and 7, 44 (63.8%) needed UAE following evacuation. Of 17 women scoring 8– 10, 10 women (58.8%) underwent laparoscopic surgery. A cut-off of 4.145 was obtained by ROC curve for prediction of any salvage treatment; this was comparable to the scale’s conventional cut-off of 4. The cut-off score for women requiring laparoscopic surgery was 6.580, which was lower than 8 obtained in the scale’s initial validation.Conclusion: The overall performance of the 10-point scoring system was moderate for predicting successful treatment modalities of women with CSP, but the scale showed good predictive ability in recognizing women needing only evacuation before recovery.Keywords: cesarean scar pregnancy, 10-point scoring system, validation, evacuation