Clinical efficacy and safety between high-intensity focused ultrasound and uterine artery embolization for cesarean scar pregnancy: a systematic review and a meta-analysis

Abstract

Background: It was reported that high-intensity focused ultrasound (HIFU) of cesarean scar pregnancy (CSP) can locally inactivate pregnancy tissue. Uterine artery embolization (UAE) can achieve good results for CSP too. To investigate the clinical efficacy and safety of HIFU and UAE in the treatment of cesarean scar pregnancy (CSP), we conducted this research.Methods: Multiple databases were used to search for relevant studies and articles related to HIFU, UAE, and CSP. The selected literature were retrospectively evaluated using Review Manager 5.2. In addition, forest plots, sensitivity analysis, and bias analysis were conducted for the included literature.Results: Finally, 8 related studies met the inclusion criteria. There were no significant differences in postoperative adverse reactions and hospitalization time between the HIFU group and the UAE group. However, the normalization time of serum beta human chorionic gonadotropin (B-HCG) in the HIFU group was higher than that in the UAE group [MD =1.16, 95% confidence interval (CI), 0.09, 2.22, P=0.03, I 2 =93%], and the hospitalization cost in the HIFU group was significantly lower than that in the UAE group (MD =−8.81, 95% CI, −12.64, −4.97, P<0.00001, I 2 =99%).Discussion: Our results show that HIFU and UAE have the same curative effect in the treatment of CSP, but HIFU has lower cost and fewer complications. These results supported that compared with UAE, HIFU is a better choice for CSP patients with long gestational age, large gestational sac diameter and high HCG level.

A review of high-intensity focused ultrasound as a novel and non-invasive interventional radiology technique

“…Another advantage is that the SonoVue contrast agent can distinguish non-treated tissue and left tissue blood supply. 16 Another guidance with MRI HIFU system include workstation and console, control therapy station with a computer. The MRI device contains a US transducer which is set on a mechanical arm.…”

“…HIFU is the best choice for CSP patients with a high hCG level, large gestational sac, and long gestational time, especially for patients with re-pregnancy at the scar site after cesarean section, which can increase the uterine retention rate. 30 HIFU is safe, effective, precise, requires no X-ray exposure, and causes less pain in the treatment of CSP patients. It can retain the functional integrity of the uterus.…”

Clinical efficacy and re-pregnancy outcomes of patients with previous cesarean scar pregnancy treated with either high-intensity focused ultrasound or uterine artery embolization before ultrasound-guided dilatation and curettage: a retrospective cohort study

“…At present, many studies have shown that HIFU-a combined with curettage is safe and efficient in treating patients with CSP [ 14 , 15 ], and several studies have further reported successful re-pregnancies after this treatment [ 15 , 16 ]. However, there is insufficient comparative research evidence on subsequent pregnancy outcomes after previous CSP treatment [ 17 ].…”