Impact of early postoperative human chorionic gonadotropin change direction after high-intensity focused ultrasound on ultrasound-guided dilation and curettage outcomes in cesarean scar pregnancy: a retrospective study.
The direction of β-hCG change after high-intensity focused ultrasound does not appear to reliably predict procedural outcomes in cesarean scar pregnancy.
Where it sits
this study against the rest of the hcg (human chorionic gonadotropin) corpusSummary and findings
This study assessed the influence of serum β-hCG changes after high-intensity focused ultrasound on outcomes in cesarean scar pregnancy. A total of 210 patients were divided into two groups based on β-hCG direction after treatment. No significant differences in procedural outcomes were observed between the groups.
Abstract
Objective To assess whether the changing direction of serum β-subunit of human chorionic gonadotropin (β-hCG) after high-intensity focused ultrasound (HIFU) and before ultrasound-guided dilation and curettage (USg-D&C) influences procedural safety and outcome in caesarean scar pregnancy (CSP). Methods This retrospective study was conducted at Deyang People's Hospital, Deyang, China. A total of 210 patients with cesarean scar pregnancy (CSP) were enrolled and divided into two groups based on the direction of serum β-hCG change after HIFU: the hCG declining group (n = 75) and the hCG rising group (n = 135). Baseline features, sonication parameters, blood loss, use of adjuvant haemostasis, re-intervention rate and time to β-hCG normalisation were compared. Results No significant differences were found in baseline data or HIFU parameters between groups. β-hCG on post-curettage day 1 remained higher in the rising group (p < 0.05), yet the percentage drop from post-HIFU value was similar in two groups (p > 0.05). Median intra-curettage blood loss (10 vs 20 mL), adjuvant haemostatic procedures (4.0% vs 6.7%) and re-intervention (6.7% vs 7.4%) also showed no differences (all p > 0.05). Conclusion In this cohort, a post-HIFU rise or fall in β-hCG was not associated with differences in USg-D&C procedure, blood loss or re-intervention. These findings do not establish equivalence, but suggest that short-term β-hCG direction alone may not be a reliable predictor of procedural outcomes.
Background
This paper addresses the clinical question of whether changes in serum β-hCG levels after high-intensity focused ultrasound (HIFU) can predict outcomes in ultrasound-guided dilation and curettage (USg-D&C) for cesarean scar pregnancy (CSP). Previous studies have suggested that β-hCG levels may correlate with procedural outcomes, but the evidence is not definitive. Understanding this relationship is important for improving patient management and procedural safety.
Methods
This retrospective study included 210 patients with cesarean scar pregnancy at Deyang People's Hospital, China. Patients were divided into two groups based on the direction of serum β-hCG change after HIFU: a declining group (n=75) and a rising group (n=135). The study compared baseline features, sonication parameters, intra-curettage blood loss, use of adjuvant haemostasis, re-intervention rates, and time to β-hCG normalization.
Results
No significant differences were found in baseline data or HIFU parameters between the two groups. On post-curettage day 1, β-hCG levels were higher in the rising group (p<0.05). However, median intra-curettage blood loss was 10 mL in the declining group compared to 20 mL in the rising group, with no significant difference (p>0.05). Adjuvant haemostatic procedures occurred in 4.0% of the declining group versus 6.7% of the rising group, also not significant (p>0.05). Re-intervention rates were 6.7% in the declining group and 7.4% in the rising group, with no significant difference (p>0.05).
Interpretation
The findings suggest that the direction of β-hCG change after HIFU does not significantly influence the safety or outcomes of USg-D&C procedures. While the study reports statistically significant differences in β-hCG levels, the clinical relevance of these findings is questionable given the lack of differences in procedural outcomes. Limitations such as the retrospective design and single-center data may affect the generalizability of the results.
Key findings
- β-hCG on post-curettage day 1 remained higher in the rising group, p<0.05.
- Median intra-curettage blood loss was 10 mL in the declining group vs 20 mL in the rising group, p>0.05.
- Adjuvant haemostatic procedures were 4.0% in the declining group vs 6.7% in the rising group, p>0.05.
- Re-intervention rates were 6.7% in the declining group vs 7.4% in the rising group, p>0.05.
- The percentage drop from post-HIFU value was similar in both groups, p>0.05.
Limitations
- Retrospective study design.
- Single-center experience.
- No randomization, potential selection bias.
- Small sample size in the declining group (n=75).
- Short follow-up period.