Curettage after uterine artery embolization combined with methotrexate treatment for caesarean scar pregnancy

Feng, Ying; Chen, Suwen; Li, Changdong; Zhang, Xiaofeng; Duan, Hua; Sooranna, Suren R.; Johnson, Mark R.; Li, Jian

doi:10.3892/etm.2016.3489

Cited by 16 publications

(17 citation statements)

References 23 publications

(51 reference statements)

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“…Vascular occlusion with gelfoam causes acute necrotizing arteritis. [ 18 ] UAE followed by surgery is widely used by doctors because it is safe and effective. The inflammatory process of UAE eventually leads to the breakdown of the gelfoam within 1 to 3 weeks after embolization with subsequent vascular recanalization.…”

Section: Discussionmentioning

confidence: 99%

The effects of methotrexate and uterine arterial embolization in patients with cesarean scar pregnancy

Xiao

Cheng²,

Chen³

et al. 2019

Medicine

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In this study, we explored the optimal treatment for cesarean scar pregnancy (CSP). One hundred three women diagnosed with CSP received 1 of the 3 treatments: local or systemic methotrexate (MTX) injection and surgery (MTX + Surg), uterine arterial embolization (UAE) and surgery (UAE + Surg) or surgery only (Surg only). We compared their therapeutic effects and their follow-up results. There was no significant difference between the groups in the baseline of clinical characteristic except for the initial β human chorionic gonadotropin levels, which was highest in the MTX + Surg group (median, [interquartile range]), (120,004 [16,720–181,727] mIU/mL), compared to the UAE + Surg group (38,219 [23,194–100,029] mIU/mL) and Surg only group (22,557 [9113–49,573] mIU/mL). There was no significant difference between groups in the sonographic characteristic of patients. The intraoperative hemorrhage was highest in the Surg-only group (7/42, 16.67%), compared to the MTX + Surg group (4/26, 15.38%) and the UAE + Surg group (0/35, 0%). The incidence of intrauterine adhesions was highest in the UAE + Surg group (20%), compared to the MTX + Surg group (0%) and the Surg only group (0%). The incidence of embryo residue was highest in Surg-only group (21.43%), compared to the MTX + Surg group (0%) and the UAE + Surg group (2.86%). To conclude, MTX injection plus surgery might be the best treatment for CSP patients.

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Section: Discussionmentioning

confidence: 99%

The effects of methotrexate and uterine arterial embolization in patients with cesarean scar pregnancy

Xiao

Cheng²,

Chen³

et al. 2019

Medicine

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“…The reduce of uterine blood supply by UAE was impermanently, since the gelfoam could be resolved within 7-14 days. Depending on this mechanism, most authors theoretically suggested that curettage should be taken within 24-72 hours after UAE to balance the bene t of onset time and the risk of recanalization [5][6][7][8][9][10][11]. Currently, it is only a clinical opinion which still needs reliable clinical evidence.…”

Section: Discussionmentioning

confidence: 99%

“…However, the timing of curettage after UAE remains to be studied. In previously reported studies, the time intervals between UAE and curettage were quite different, ranging from 24 to 72 hours [5][6][7][8][9][10][11]. There is no consensus on the optimal time interval to perform curettage after UAE.…”

Section: Introductionmentioning

confidence: 99%

When to Perform Curettage After Uterine Artery Embolization for Cesarean Scar Pregnancy: a Clinical Study

Wang

Peng

Zhao

et al. 2021

Preprint

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Background: Prophylactic uterine artery embolization (UAE) combined with following curettage was suggested as an effective and minimally invasive treatment strategy for cesarean scar pregnancy (CSP) with high bleeding risk. However, the timing of curettage after UAE remains to be studied. Thus, we aimed to identify the optimal time interval to perform curettage after UAE in patients with CSP.Methods: We conducted a retrospective cohort study in a large medical center for women and children in southwest China. CSP patients treated by UAE combined with following curettage were included and grouped by the treatment time interval between these two procedures. The clinical outcomes among arms were compared by univariate and multi-variable analysis.Results: Our study finally included a total of 314 CSP patients who received this combination treatment in our department from January 2014 to December 2019. The median time interval between UAE and curettage was 48 hours with a range of 12-168 hours in all participants. Thirty-two cases (10.2%) experienced intra-operative hemorrhage (blood loss ≥200mL). Seventeen cases (5.4%) used intrauterine balloon tamponade. Fourteen cases (4.5%) were converted into laparoscopy (or laparotomy). In the cohort study, patients with longer treatment interval had more intra-operative blood loss and higher incidence of complications than those with shorter interval (P＜0.05). The rate of intra-operative bleeding was 5.0% in patients who received curettage within 24 hours after UAE (Arm 1), in comparison with 19.4% in those who had treatment interval longer than 72 hours (Arm 4). In the multi-variable logistic regression model of bleeding, the treatment interval ＞72 hours had an adjusted odds ratio of 3.37 (95% confidence interval: 1.40-8.09). Conclusion: We suggest that curettage should not be delayed longer than 72 hours after UAE under general conditions.

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“…As a non-invasive therapy, recent studies have demonstrated that UAE can block uterine artery blood flow, which results in trophoblastic cell degeneration and necrosis ( 17 ). UAE, in combination with drugs or curettage, can achieve better curative effects ( 18 , 19 ). A study revealed that the gestational age of CSP is >8 weeks, and a CSP mass of ≥6 cm tends to have an unsatisfactory outcome after UAE, followed by curettage ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Analysis of the Treatment of Cesarean Scar Pregnancy by High-Intensity Focused Ultrasound, Uterine Artery Embolization and Surgery

et al. 2020

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Objective: This study aims to retrospectively analyze the clinical curative effects of surgery, uterine artery embolization (UAE), and high-intensity focused ultrasound (HIFU) in order to provide the theory and evidences for selecting the optimal treatment for cesarean scar pregnancy (CSP). Methods: Women with CSP were treated with surgery (laparoscopic, hysteroscopy, and hysteroscopy–laparoscopic surgery), UAE combined with curettage, and HIFU combined with curettage. The general conditions and therapeutic effects, including vital signs during the operation, discomfort of discharge, cure rate, total blood loss, decline in the rate of hCG, and hospital stay, were compared and analyzed. Results: For the 154 CSP patients, the cure rate of surgery ( n = 95) was 97.89%, the cure rate of UAE ( n = 32) was 43.74%, and the cure rate of HIFU ( n = 27) was 70.37%. The difference was statistically significant ( P < 0.05). Furthermore, the hCG level of surgical patients quickly declined, whereas HIFU slowly declined. The difference between the decline rate of hCG and mean hospitalization time was statistically significant ( P < 0.05). UAE was good for CSP with gestational age <60 days and diameter of gestational sac <40 mm. Furthermore, HIFU was well for CSP patients with a gestational age of <55 days and a gestational sac diameter of <30 mm. Surgery was suitable for any type of these cases. Conclusion: CSP patients with short gestational age and small gestational sac can be treated with surgery, UAE, and HIFU, and achieve safe and effective therapeutic effects. Surgery is also a good choice for CSP for patients with a long gestational age, a large gestational sac diameter, high levels of hCG, or an ample blood supply.

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Curettage after uterine artery embolization combined with methotrexate treatment for caesarean scar pregnancy

Cited by 16 publications

References 23 publications

The effects of methotrexate and uterine arterial embolization in patients with cesarean scar pregnancy

The effects of methotrexate and uterine arterial embolization in patients with cesarean scar pregnancy

When to Perform Curettage After Uterine Artery Embolization for Cesarean Scar Pregnancy: a Clinical Study

A Retrospective Analysis of the Treatment of Cesarean Scar Pregnancy by High-Intensity Focused Ultrasound, Uterine Artery Embolization and Surgery

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