Uterine artery embolization plus ultrasound guided curettage for cesarean scar pregnancy: Five-year experience at a single tertiary hospital

Abstract

Objective

To study immediate therapeutic outcomes, subsequent fertility effects and menstrual changes in cesarean scar pregnancy patients who received uterine artery embolization with or without methotrexate followed by ultrasound guided curettage.

Materials and methods

Totally, 82 patients who met the inclusion criteria were enrolled in our study and divided into two groups. Group I included 50 patients who received uterine artery embolization and ultrasound guided curettage, and Group II had 32 patients who received uterine artery embolization plus methotrexate and ultrasound guided curettage.

Results

No significant difference was found in demographic features between the two groups, but the level of serum β-human chorionic gonadotropin before uterine artery embolization, 1 day and 7 days after ultrasound guided curettage is significantly higher in Group II than that in Group I. Patients were followed up for a mean time of 38.9 months. 10 patients had reproductive desire and half of them failed while half succeeded including one recurrent cesarean scar pregnancy. Most patients (74.4 %) had no menstrual changes, while 19 patients complaint a decrease in menstruation and 2 patients had a prolonged menstruation.

Conclusion

Uterine artery embolization combined with or without methotrexate plus ultrasound guided curettage is an effective, safe and recommended therapy to eliminate the gestational sac and meanwhile to preserve fertility for cesarean scar pregnancy patients, and methotrexate could help reduce the blood level of β-human chorionic gonadotropin and shorten the days to recover to normal, thus reducing hospitalized days.