Uterine artery embolization followed by dilation and curettage within 24 hours compared with systemic methotrexate for cesarean scar pregnancy

• Published in: International journal of gynecology and obstetrics 2014-11, Vol.127 (2), p.147-151
• Main Authors: Gao, LvFen, Huang, Zhongwei, Gao, Jie, Mai, Haoshan, Zhang, Yiting, Wang, Xiaoyu
• Format: Article
• Language: English
• Subjects: Abortifacient Agents, Nonsteroidal - adverse effects; Abortifacient Agents, Nonsteroidal - therapeutic use; Adult; Cesarean scar pregnancy; Cesarean Section; China; Cicatrix; Dilatation and Curettage - adverse effects; Female; Hemorrhage - etiology; Humans; Length of Stay; Methotrexate - adverse effects; Methotrexate - therapeutic use; Obstetrics and Gynecology; Pregnancy; Pregnancy, Ectopic - drug therapy; Pregnancy, Ectopic - surgery; Retrospective Studies; Systemic methotrexate; Uterine Artery Embolization; Uterine curettage
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1016/j.ijgo.2014.05.005

Abstract Objective To assess the efficacy of uterine artery embolization (UAE) combined with dilation and curettage (D&C) within 24 hours for the treatment of a cesarean scar pregnancy (CSP), compared with methotrexate and D&C. Methods A retrospective cohort study of 119 women with CSP was conducted at two tertiary hospitals in Guangzhou and Shenzhen, China, during 2009–2012. Twenty-six women received systemic methotrexate followed by D&C, and 93 women were treated with UAE followed by D&C within 24 hours. Results Mean blood loss was 261.0 ± 357.4 mL in the methotrexate group versus 14.1 ± 40.6 mL in the UAE group ( P < 0.001). The time to resolution of the level of β-human chorionic gonadotropin was 40.5 ± 17.2 days versus 15.4 ± 7.7 days ( P < 0.001), respectively. The duration of hospitalization was 14.6 ± 9.2 days versus 6.2 ± 3.7 days ( P < 0.001), respectively. An additional intervention was needed in 9 (35%) women in the methotrexate group and in 5 (5%) in the UAE group ( P < 0.001). Conclusion UAE combined with D&C within 24 hours was an effective uterine preservation treatment for CSP, and was associated with less blood loss and a shorter hospital stay than administration of methotrexate followed by D&C.