High-Intensity Focused Ultrasound or Uterine Artery Embolization Combined With Ultrasound-Guided Dilatation and Curettage in Cesarean Scar Pregnancy: A Retrospective Cohort Study
Abstract BackgroundCesarean scar pregnancy (CSP) is a rare and new form of ectopic pregnancy. With increasing rate of cesarean delivery worldwide during the decades, the incidence of CSP increases as well. It may cause massive hemorrhage, uterine rupture, placenta percreta, hysterectomy or even maternal death. This study is to compare the efficacy of high-intensity focused ultrasound (HIFU) and uterine artery embolization (UAE) associated with ultrasound-guided dilatation and curettage (UGDC) in three types of CSP. Methods403 CSP patients were treated with UGDC after pretreatment. Among them, 288 patients chose HIFU before UGDC, while the others (n=115) chose UAE. The body mass index (BMI), gravidity, parity, the number of cesarean delivery, the interval of previous cesarean delivery (PCD), the length, thickness and width of uterus and gestational sac, fetal cardiac activity, the types of CSP, the baseline of beta-human chorionic gonadotropin (β-HCG), the value of β-HCG before and 24 hours after pretreatment, hospital expenditure, the value of hemoglobin before and 24 hours after dilatation and curettage (D&C) and severe complications were collected and compared between the two groups. ResultsAll patients were successfully treated without severe complications. There was no significant difference in maternal age, BMI, gravidity, parity, the number of cesarean delivery, the interval of PCD, the volume of uterus and gestational sac, fetal heart activity, types of CSP and baseline serum β-HCG level between the two groups. The median hospital expenditure and blood loss were less in HIFU group and the median decline rate of β-HCG was higher in HIFU group (p=0.000, p=0.000, p=0.006, respectively). 39 (13.54%) patients in HIFU group, while 21 (18.26%) cases in UAE group used Foley balloon to control the vaginal bleeding.ConclusionBoth HIFU and UAE combined with UGDC have high successful rate in the treatment of CSP. While, HIFU followed by UGDC might be better for less hospital expenditure, blood loss and higher decline rate of β-HCG.
