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. 2025 Feb 3;25(1):107.
doi: 10.1186/s12884-025-07255-2.

A prediction nomogram for residual after negative pressure aspiration for endogenic cesarean scar ectopic pregnancy: a retrospective study

Yan Lei #  1 , Na Zhang #  2 , Yu Liu #  2 , Xin Du #  2
Affiliations

A prediction nomogram for residual after negative pressure aspiration for endogenic cesarean scar ectopic pregnancy: a retrospective study

Yan Lei et al. BMC Pregnancy Childbirth. .

Abstract

Background: We aimed to establish a predictive nomogram to evaluate the incidence of residual tissue in patients with endogenic cesarean scar ectopic pregnancy after negative pressure aspiration.

Methods: This retrospective study included patients treated in the gynecology department of our institution from May 2017 to August 2023 who underwent negative pressure suction treatment, ultrasound examinations before and after treatment, and received telephone follow-up for at least 6 months. A total of 899 patients met the inclusion criteria and were divided into a training cohort (629 patients, 70%) and a validation cohort (270 patients, 30%). Independent predictive factors were established using multivariate logistic regression. The resulting nomogram was validated using 1,000 bootstrap resampling, and calibration curves were plotted. Receiver operating characteristic (ROC) analysis was performed to calculate the area under the curve, sensitivity, specificity, and other metrics to assess its discriminative performance. Clinical decision curves were constructed to evaluate clinical applicability and quantify the net benefit within a range of threshold probabilities. The model was externally validated in the validation cohort.

Results: Predictive factors included in the nomogram included age (hazard ratio [HR]: 1.220, 95% confidence interval [CI]: 1.135-1.316), BMI (HR: 0.890, 95% CI: 0.796-0.986), intraoperative major hemorrhage (HR: 4.457, 95% CI: 1.610-12.292), maximum diameter of the gestational sac (HR: 1.572, 95% CI: 1.295, 1.914), and thickness of the remaining muscle layer of the lower uterine segment (HR: 1.572, 95% CI: 0.014, 0.430). The ROC curve of the resulting nomogram showed similar area under the curve values for the training (0.809, 95% CI: 0.751-0.867) and validation cohorts (0.814, 95% CI: 0.739, 0.888). The Hosmer-Lemeshow test indicated good model fit (P = 0.861), and the calibration curve was close to the ideal diagonal line. Decision curve analysis demonstrated good net benefit, and external validation confirmed its reliability.

Conclusions: The model may aid in individual clinical decision-making, allowing clinicians to perform immediate postoperative assessments for patients with endogenous ectopic pregnancy in cesarean section scars treated with negative pressure suction, identify high-risk subpopulations, and select appropriate supplementary treatment in advance, making it particularly suitable for low-income areas and resource-limited primary hospitals.

Keywords: Cesarean scar ectopic pregnancy; Endogenic cesarean scar ectopic pregnancy; Prediction nomogram; Residual.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study involves human participants.Ethical clearance and support letters were obtained from the Ethical Committee with the reference number 2023IEC123 in November,2023.The methods were conducted following the tenets of the Helsinki declaration. Before collecting data, an information sheet was read to all eligible study participants to obtain oral informed consent. The privacy of the respondents was respected and data were deidentified before analysis and reported in aggregate. Participants gave informed consent to participate in the study before taking part. Consent for publication: We confirm that all authors have read and approved the final version of the manuscript and agree with its submission for publication. We also affirm that this manuscript has not been submitted to any other publication concurrently. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
RStudy profile. CSEP=cesarean scar ectopic pregnancy
Fig. 2
Fig. 2
Nomogram of residual prediction after CSEP negative pressure aspiration. CSEP=cesarean scar ectopic pregnancy
Fig. 3
Fig. 3
ROC curves. A Training cohort. B Validation cohort. ROC=receiver operating characteristic; AUC=area under the ROC curve
Fig. 4
Fig. 4
Calibration curve for predicting residual incidence after negative pressure aspiration in CSEP patients. A Training cohort. B Validation cohort. CSEP=cesarean scar ectopic pregnancy
Fig. 5
Fig. 5
Decision curve analysis in prediction of postoperative residual in patients with CSEP. A Training cohort. B Validation cohort.CSEP=cesarean scar ectopic pregnancy
Fig. 6
Fig. 6
Instructional Diagram for the Use of the Nomogram. The first points row, serves as the scoring reference for each variable. For any given patient, we can calculate the scores of all predictive variables as indicated by the red dashed arrows in the figure. The total score obtained can then be mapped through total points to the Risk of status, indicated by the red solid arrow, to derive the residual probability of the patient following CSEP negative pressure aspiration. BMI= body mass index ,CSEP= Cesarean scar ectopic pregnancy
See this image and copyright information in PMC

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