Clinical outcome and analysis of procedural failure during uterine artery chemoembolisation as a treatment of caesarean scar pregnancy

Abstract

Introduction Caesarean scar pregnancy (CSP) is a relatively rare yet life-threatening condition in which the embryo is implanted in the scar after caesarean section. Recent studies have reported that uterine artery chemoembolisation (UAC) can be safe and effective method in treating CSP. Aim To present the clinical outcome of UAC with a mixture of methotrexate and gelatine sponge for the treatment of CSP and analysis of procedural failure. Material and methods Forty-one patients diagnosed with CSP were treated with selective endovascular chemoembolisation of uterine arteries. Short- and long-term results, reasons for procedural failure, and clinical outcome were analysed. Results Primary procedure failed in 7 out of 41 (17%) cases. In 4 cases additional blood supply to the CSP was disclosed; 3 out of 4 from an ovarian artery and one from a superior vesical artery. In other 3 patients, reperfusion of uterine arteries was observed. All these 7 patients underwent successful secondary embolisation. The majority of the followed-up patients reported regular menses after the intervention. Four women suffered from amenorrhoea and 2 from hypomenorrhoea that continued after 90 days. Twelve patients expressed the desire for subsequent pregnancy. From this group, 5 conceived within a year of the procedure. The rest did not achieve a pregnancy. Conclusions UAC proved to be a safe and effective method and should be considered as an option for CSP treatment, especially for women hoping to preserve their fertility. However, the presence of collateral blood supply should always be considered.

Effect of Uterine Arterial Chemoembolization Combined with Ultrasound-Guided Uterine Curettage on Cervical Pregnancy and Influencing Factors

“…At the same time, UACE is a means of interventional treatment, which embolizes blood vessels by injecting embolic agents into the uterine artery to reduce the occurrence of major bleeding. UACE combined with uterine debridement is less damaging to patients with cervical pregnancy, relatively simple to perform, and has less impact on patients' fertility, allowing for a faster recovery and a more effective improvement in prognosis, making it an acceptable treatment for patients [ 20 , 21 ].…”

Advances in Treating Cesarean Scar Pregnancy: A Comprehensive Review of Techniques, Clinical Outcomes, and Fertility Preservation

“…Indications for chemoembolization for CSP include: presence of a live or viable embryo located in the cesarean scar, gestational age less than 12 weeks, absence of significant maternal symptoms or complications such as heavy vaginal bleeding or signs of hemodynamic instability, and refractory to or contraindications to other treatments such as methotrexate injection or dilation and curettage (D&C) [ 22 ]. Many authors have described successful chemoembolization procedures despite the presence of fetal heart activity, so it is not a contraindication to the procedure [ 23 – 25 ].…”

“…The chemoembolization procedure is performed by experienced interventional radiologists under local anesthesia from the femoral access. Intraoperative angiography allows effective imaging of the anatomy with special attention to the uterine arteries and the possible presence of anastomoses that could hinder the procedure [ 23 ]. The standard dose used in the next step of the procedure is 50 mg of methotrexate, 25 mg in each of the uterine arteries, which directly supply blood to the embryo [ 26 ].…”

“…The abnormal bleeding that occurred in one patient and the rich vascularization of the CSP originating from the ovarian artery in the other required repeated embolization. Of the 41 patients described by Pyra et al, treatment was successful in 34 patients (83%), and 7 patients required secondary treatment [ 23 ]. A retrospective study of 383 patients who underwent chemoembolization showed treatment success in 379 patients (99%) [ 24 ].…”

“…On the other hand, successful pregnancy rates of 30% following the uterine artery chemoembolization have been reported [ 23 ]. A large study found a 54% success rate of live births among patients seeking pregnancy [ 24 ].…”