scholarly journals Uterine Artery Embolization Combined with Subsequent Suction Evacuation as Low-Risk Treatment for Cesarean Scar Pregnancy

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2350
Author(s):  
Roxana Bohiltea ◽  
Ionita Ducu ◽  
Bianca Mihai ◽  
Ana-Maria Iordache ◽  
Bogdan Dorobat ◽  
...  
Keyword(s):  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Uterine Cavity ◽  
Positive Outcome ◽  
Low Risk ◽  
Artery Embolization ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Severe Hemorrhage ◽  
Risk Treatment

Objective: The aim of this study is to propose a standardized management of care for patients diagnosed with cesarean scar pregnancy (CSP). There are two types of CSP: Type 1 (on the scar) vs. type 2 (in the niche). To date there is no international standard to predict the extent of invasion or the optimal management of CSP. Materials and methods: We used intramuscular methotrexate injection followed by uterine artery embolization combined with suction evacuation as a conservative approach for the treatment of seven patients diagnosed with CSP. Our inclusion criteria, to be satisfied simultaneously, were established as follows: (1) patients with CSP; (2) early gestational age ≤ 9 weeks, and (3) written consent of the proposed treatment of the patient. Results: This course of treatment produced a positive outcome in all cases. We did not have any complications (e.g., emergency hysterectomy, perforation of the uterine cavity, severe hemorrhage, or endometritis) during the procedures or in the follow-up. The most important predictors of successful management are early diagnosis of CSP and orientation of the invasive trophoblast opposite to the scar. Conclusions: The main finding from this series of cases is that associating systemic methotrexate and uterine artery embolization provides efficient and low-risk management of CSP. This treatment regime is adequate for both types of CSPs. We consider that early localization diagnosis of pregnancy following a cesarean delivery is mandatory for CSP morbidity prevention.

scholarly journals The Analysis of Efficacy and Failure Factors of Uterine Artery Methotrexate Infusion and Embolization in Treatment of Cesarean Scar Pregnancy

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Xiao An ◽  
Xu Ming ◽  
Ke Li ◽  
Jingbing Wang
Keyword(s):  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Transcatheter Arterial Chemoembolization ◽  
Clinical Effects ◽  
Artery Embolization ◽  
Cesarean Scar Pregnancy ◽  
Embolic Material ◽  
Cesarean Scar ◽  
Severe Hemorrhage ◽  
Arterial Chemoembolization

Objectives. This study observes therapeutic efficacy of uterine artery embolization combined with MTX infusion which terminates cesarean scar pregnancy (CSP) and induces three factors which probably relate to failure.Methods. Twenty-three CSP patients were treated with combined uterine artery MTX infusion and embolization. Among them six patients with severe hemorrhage were immediately treated with interventional operation. Clinical effects were estimated by symptoms, serum -hCG, ultrasound, and MR.Results. Interventional treatments were technologically successful in 22 patients except one. Immediate hemostasis was achieved in all 6 patients with massive colporrhagia. No occurrence of infection and uterine necrosis was observed, but 12 women suffered abdominal pains. Nineteen patients’ uteri were preserved, whereas four underwent hysterectomy eventually.Conclusions. Transcatheter arterial chemoembolization is effective to treat high-risk CSP in preference to hysterectomy. To achieve more successful outcomes, three factors should be highlighted: adequate MTX dosage, appropriate embolic material, and complete embolization of target arteries that supply blood to embryo in the scar.

scholarly journals Successful Conservative Treatment of a Cesarean Scar Pregnancy with Systemically Administered Methotrexate and Subsequent Dilatation and Curettage: A Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Anis Fadhlaoui ◽  
Mohamed Khrouf ◽  
Khaled Khémiri ◽  
Kais Nouira ◽  
Anis Chaker ◽  
...  
Keyword(s):  
Case Report ◽  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Artery Embolization ◽  
Cesarean Scar Pregnancy ◽  
Rare Type ◽  
Cesarean Scar ◽  
Dilatation And Curettage ◽  
Severe Hemorrhage ◽  
The Cost

Cesarean scar pregnancy is a rare type of ectopic pregnancy associated with severe complications such as uterine rupture, uncontrollable bleeding which may lead to hysterectomy, and definitive infertility. Many therapeutic options are available such as Dilatation & Curetage, excision of trophoblastic tissues using either laparotomy or laparoscopy, systemically administered Methotrexate, and more recently uterine artery embolization. The use of Methotrexate sometimes required laparotomy later because of severe hemorrhage. Through this paper, we demonstrated that viable cesarean scar pregnancy can be managed safely by systemically delivered Methotrexate at the cost of a prolonged followup.

scholarly journals Risk factors for poor hemostasis of prophylactic uterine artery embolization before curettage in cesarean scar pregnancy

2020 ◽  
Vol 48 (10) ◽  
pp. 030006052096437
Author(s):  
Hongan Tian ◽  
Shunzhen Li ◽  
Wanwan Jia ◽  
Kaihu Yu ◽  
Guangyao Wu
Keyword(s):  
Risk Factors ◽  
Blood Supply ◽  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Embolic Agent ◽  
Artery Embolization ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Hemorrhage Volume ◽  
Gestational Sac

Objective To observe the hemostatic effect of prophylactic uterine artery embolization (UAE) in patients with cesarean scar pregnancy (CSP) and to examine the risk factors for poor hemostasis. Methods Clinical data of 841 patients with CSP who underwent prophylactic UAE and curettage were retrospectively analyzed to evaluate the hemorrhage volume during curettage. A hemorrhage volume ≥200 mL was termed as poor hemostasis. The risk factors of poor hemostasis were analyzed and complications within 60 days postoperation were recorded. Results Among the 841 patients, 6.30% (53/841) had poor postoperative hemostasis. The independent risk factors of poor hemostasis were gestational sac size, parity, embolic agent diameter (>1000 μm), multivessel blood supply, and incomplete embolization. The main postoperative complications within 60 days after UAE were abdominal pain, low fever, nausea and vomiting, and buttock pain, with incidence rates of 71.22% (599/841), 47.44% (399/841), 39.12% (329/841), and 36.39% (306/841), respectively. Conclusions Prophylactic UAE before curettage in patients with CSP is safe and effective in reducing intraoperative hemorrhage. Gestational sac size, parity, embolic agent diameter, multivessel blood supply, and incomplete embolization of all arteries supplying blood to the uterus are risk factors of poor hemostasis.

scholarly journals Cesarean Scar Pregnancy Treated by Artery Embolization Combined with Diode Laser: A Novel Approach for a Rare Disease

Medicina ◽  
2021 ◽  
Vol 57 (5) ◽  
pp. 411
Author(s):  
Felice Sorrentino ◽  
Vincenzo De Feo ◽  
Guglielmo Stabile ◽  
Raffaele Tinelli ◽  
Maurizio Nicola D’Alterio ◽  
...  
Keyword(s):  
Diode Laser ◽  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Artery Embolization ◽  
Artery Ligation ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Dilation And Curettage ◽  
Management Protocol ◽  
Future Fertility

Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy which represents a consequence of a previous cesarean section. It is associated with major maternal morbidity and mortality and has potential implications on future fertility. Because of possible serious complications, CSP should be swiftly diagnosed and treated. There is no management protocol for this rare, life-threatening condition, and each patient should be evaluated individually. Several types of conservative treatment have been used to treat cesarean scar pregnancy: dilation and curettage (D&C), excision of trophoblastic tissues, local or systemic administration of methotrexate, bilateral hypogastric artery ligation, and selective uterine artery embolization with curettage and/or methotrexate administration. In our study we present a cesarean scar pregnancy of a 40-year-old woman who was treated with angiographic uterine artery embolization (UAE) followed by hysteroscopic diode laser resection. Our combined UAE–hysteroscopic laser surgery appears to offer an effective, safe, and minimally invasive surgical treatment.

scholarly journals Management of Cesarean Scar Pregnancy: A Single-Institution Retrospective Review

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
P. Giampaolino ◽  
N. De Rosa ◽  
I. Morra ◽  
A. Bertrando ◽  
A. Di Spiezio Sardo ◽  
...  
Keyword(s):  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Ultrasound Guidance ◽  
Expectant Management ◽  
Artery Embolization ◽  
Maternal Complications ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Vacuum Aspiration ◽  
Manual Vacuum Aspiration

Objective. Cesarean scar pregnancy (CSP) is a rare condition that occurs when the pregnancy implants in a cesarean scar. An early diagnosis and a proper management are fundamental to prevent maternal complications. We review and discuss the different treatment employed in our unit to reduce morbidity, preserve fertility, and predict possible complications. Methods. The reported treatment has been expectant management, operative hysteroscopy approach, and intramuscular injection of 50 mg methotrexate (MTX), followed by cervical dilation and manual vacuum aspiration (D&S) with a Karman cannula under ultrasound guidance, uterine artery embolization (UAE), and manual vacuum aspiration under ultrasound guidance and uterine artery embolization before surgical laparotomic resection. Results. Complications were more frequent in women with a history of three or more cesarean section deliveries and with a myometrial thickness thinner than 2 mm. MTX and D&S treatment appear to be most effective and safe at the early age of pregnancy, while UAE and D&S are related to the highest risk of complication in any age of pregnancy. Conclusion. An appropriate preoperative diagnostic evaluation, the identification of cases at higher risk, and those eligible for a conservative treatment are fundamental to reduce complications.

scholarly journals Successful Management of a Scary Case of Cesarean Scar Pregnancy with Combined Treatment using Methotrexate, Uterine Artery Embolization and Suction Evacuation

2015 ◽  
Vol 7 (3) ◽  
pp. 143-147
Author(s):  
Santhosh Joseph ◽  
Gonnabaktula Naga Vasanthalakshmi ◽  
Usha Vishwanath ◽  
M Anitha
Keyword(s):  
Uterine Rupture ◽  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Combined Treatment ◽  
Successful Management ◽  
Artery Embolization ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Dilatation And Curettage ◽  
Future Fertility

ABSTRACT Cesarean scar pregnancy (CSP) is the rarest type of ectopic pregnancy implanted in the myometrium at the site of the previous cesarean section scar. It may lead catastrophic complications like uterine rupture and uncontrollable hemorrhage.4 Early diagnosis can offer treatment options of avoiding uterine rupture and hemorrhage, thus, preserving the uterus and future fertility. The conservative treatment can be by local and/or systemic administration of methotrexate, dilatation and curettage, excision of trophoblastic tissues (laparoscopy/laparotomy), bilateral internal artery ligation with trophoblastic evacuation and uterine artery embolization7 combined with curettage and/ or methotrexate. We did successful treatment of a viable CSP by systemic injections of methotrexate followed by selective uterine artery embolization in combination with dilatation and curettage. How to cite this article Mehta P, Vishwanath U, Joseph S, Anitha M. Successful Management of a Scary Case of Cesarean Scar Pregnancy with Combined Treatment using Methotrexate, Uterine Artery Embolization and Suction Evacuation. J South Asian Feder Obst Gynae 2015;7(3):143-147.

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