High-Intensity Focused Ultrasound Combined With Suction Curettage for the Treatment of Cesarean Scar Pregnancy

Zhu, Xiaogang; Deng, Xingming; Wan, Yajun; Xiao, Songshu; Huang, Jiping; Zhang, Lian; Xue, Min

doi:10.1097/md.0000000000000854

Cited by 46 publications

(69 citation statements)

References 23 publications

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“…The aim of the operation was to remove the non-implanted part of the placenta; the deeply implanted part of the placenta was left in situ, to be absorbed slowly after the HIFU ablation. The average depth of the uterus was 10.36 AE 2.14 cm (range [8][9][10][11][12][13][14][15]. The median volume of any intraoperative blood loss was 20 ml (range 5-400); no blood transfusions were given.…”

Section: Hysteroscopic Operationmentioning

confidence: 99%

“…[9][10][11][12] Some reports on the treatment of PA by HIFU have been published recently, but the risk of haemorrhage and infection when using HIFU alone, is still high. In this study, we utilised USgHIFU combined with curettage guided by hysteroscopy to treat PA patients so that the chance of unexpected haemorrhage and infection from HIFU could be reduced.…”

Section: Introductionmentioning

confidence: 99%

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High‐intensity focused ultrasound combined with hysteroscopic resection for the treatment of placenta accreta

Yin

Xue

et al. 2017

BJOG

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Objective The aim of this study was to evaluate the safety and efficacy of a combination of high-intensity focused ultrasound (HIFU) and hysteroscopic resection while treating placenta accreta (PA).Design A retrospective study.Setting A university teaching hospital in China.Methods This study included 25 patients diagnosed with PA who underwent HIFU followed by hysteroscopic resection in our hospital between January 2014 and December 2015. All patients had completed follow-up data. Treatment efficacy and safety were evaluated retrospectively.Main outcome measures Placenta accreta could be removed with hysteroscopic resection after HIFU.Results All patients received one session of HIFU ablation therapy. The median total HIFU treatment time was 18 minutes and the median exposure time was 600 seconds. During treatment, 23 lesions showed massive grey-scale changes and two lesions modest grey-scale change. Contrast-enhanced ultrasound showed signs of reduced perfusion in all lesions. During treatment, all patients tolerated the HIFU procedure well and completed the treatment. All patients complained of mild lower abdominal and sacrococcygeal pain, with a pain score ranging from 1 to 4 points. Seven patients complained of a 'hot' skin sensation. No serious complications were encountered during or after the procedure. All patients received hysteroscopic operations with a median of 2 days after HIFU treatment. The average depth of the uterus was 10.36 AE 2.14 cm. The median volume of intraoperative blood loss was 20 ml, and no blood transfusions were given. Sixteen patients underwent only one session of hysteroscopic resection and nine patients underwent a second session of hysteroscopic resection operation 11-61 days after the first operation. All patients preserved their uterus and tolerated the hysteroscopic operation well. Of the 25 patients, two had uterine perforation during the first operation. No other severe hysteroscopic complication was observed. The average hospital stay was 8.4 AE 1.6 days. After treatment the median duration of vaginal bleeding was 10 days. Twenty-one patients recovered normal menstruation 34 days after the operation. The other four patients continued breastfeeding and therefore exhibited abnormal menstruation.Conclusions HIFU treatment followed by hysteroscopic resection is safe and effective in treating patients with PA.Keywords Effectiveness, high-intensity focused ultrasound, hysteroscopy, placenta accreta, safety.Tweetable abstract For patients with placenta accreta, HIFU treatment before hysteroscopic resection could help reduce risk during the procedure of hysteroscopic resection.Please cite this paper as: Ye M, Yin Z, Xue M, Deng X. High-intensity focused ultrasound combined with hysteroscopic resection for the treatment of placenta accreta. BJOG 2017; 124 (S3): 71-77.

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Section: Hysteroscopic Operationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

High‐intensity focused ultrasound combined with hysteroscopic resection for the treatment of placenta accreta

Yin

Xue

et al. 2017

BJOG

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“…Intraarterial MTX + UAE+ combined laparoscopy and hysteroscopy 25 patients, 100% success rate. Blood loss less than 200ml [50].…”

Section: Uae+ Hysteroscopic Surgerymentioning

confidence: 99%

“…UAE combined with local MTX or systemic MTX UAE combined with local MTX infusion has been used extensively in recent years, and it has been suggested that the effects of MTX are synergistic to UAE [50,51].…”

Section: Uae+ Hysteroscopic Surgerymentioning

confidence: 99%

“…This novel treatment modality described in two high-quality case series had a success rate of 100% with no complications and no additional treatment warranted. [49][50]. Since systemic MTX injections, dilatation and curettage, and UAE are treatments that have all demonstrated high complication rates previously, combining therapeutic approaches should be considered when selecting the treatment options.…”

Section: High-intensity Focused Ultrasound Ablation (Hifu)mentioning

confidence: 99%

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Untitled

2017

IPCB

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Submit Manuscript | http://medcraveonline.com IntroductionCesarean scar pregnancy is rare but potentially life threatening type of ectopic pregnancy. It is a condition in which the concepts implants in an iatrogenic cesarean scar in the uterus and is surrounded by uterine muscular fiber, scar tissue, and thin myometrium adjacent to the bladder. It can occur in women with a single previous cesarean delivery. CSP was first described by [1]. The incidence of CSP has been reported to be 1:1800-1:2216 of normal pregnancies and accounts for 6.1% of all ectopic pregnancies [2][3][4][5]. This rate is expected to rise in the future worldwide owing to increasing rates of cesarean deliveries and awareness of its pathology. During the last two decades ultrasonography diagnosis have improved and the techniques for uterine surgery has changed .In recent time the uterus is often closed in one layer, compared with the previous twolayer technique. These factors may play a role in the increasing prevalence of CSP. Vial et al. [6] proposed two different types of CSPs; Endogenous CSP (CSP type I) and Exogenous CSP (CSP type II). CSP type I is a superficial implantation of the embryo on the cesarean scar (CS) which develop towards the cervicoisthmic space or the uterine cavity. CSP type II is a deep implantation of the embryo into a CS defect growing towards the bladder, infiltrating the uterine myometrium, and bulging from the uterine serosa. CSP type II may result in uterine rupture and hemorrhage during the first trimester of pregnancy. The above two types of CSP are easily differentiated by ultrasound or MRI examination. Due to the high risk of life-threatening complications including massive hemorrhages/shock, uterine rupture with the potential necessity for hysterectomy in worst case scenario and maternal death, CSP needs a prompt accurate and proper diagnosis and management. However, termination of pregnancy is generally recommended.Routine transvaginal ultrasonography has been recommended in early pregnancy for patients who have previously undergone a cesarean delivery [7][8][9]. The Pathogenesis and Risk Factors of CSPThe causes and mechanism of CSP is unclear, Jurkovic et al. [3] hypothesized that the pathogenesis of CSP can be explained by the presence of uterine scar dehiscence and small scar defects after cesarean deliveries. A compromise of the deciduas basal is and the nitabuch fibrinoid layer, which normally constitutes a barrier preventing trophoblast invasion into the scarred myometrium of the lower anterior uterine segment enables the concepts to invade the myometrium through this microscopic dehiscence or defect in the scar [3]. Such defects can also develop from the trauma of other uterine surgery for example; curettage, myomectomy, metroplasty, hysteroscopy and even manual removal of placenta. Seow et al. [10,11] showed a possible correlation between intrauterine device, pelvic inflammatory disease and CSP [2]. Recently Zhi-Da et al demonstrated that the increased expression of decidual integrin β3 and Leukaem...

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A rare case report of heterotopic cesarean scar pregnancy in the 8th week of gestation that was managed successfully by exploratory laparotomy with dilation and curettage

Karbasi,

Aletaha,

Ahangar‐Sirous

et al. 2024

Clinical Case Reports

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Key Clinical MessageSwift and precise identification of heterotopic cesarean scar pregnancy, coupled with standardized treatment approaches for handling possible serious complications, form an essential component in reaching favorable outcomes for patients experiencing this rare type of pregnancy.AbstractHeterotopic pregnancy (HP) denotes a form of multiple gestation where intrauterine and ectopic pregnancies coexist. Cesarean scar ectopic pregnancy, on the other hand, involves the implantation of a fetus over the previous cesarean scar. This condition poses a significant risk of uterine rupture, which may lead to serious health complications, and even death. We report a case of a fit 37‐year‐old woman with two previous cesarean deliveries who was diagnosed with a heterotopic cesarean scar pregnancy at 8 weeks gestation following symptoms of lower abdominal pain and delayed menstruation. Both pregnancies demonstrated cardiac activity and the portion of the myometrium located between the bladder wall and the gestational sac was noted to exhibit considerable thinness. The patient underwent an exploratory laparotomy coupled with dilation and curettage and recovered uneventfully. The proper management of a HCSP requires timely diagnosis through ultrasonography. Early diagnosis allows for immediate intervention to prevent complications such as uterine rupture or potentially lethal bleeding.

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High-Intensity Focused Ultrasound Combined With Suction Curettage for the Treatment of Cesarean Scar Pregnancy

Cited by 46 publications

References 23 publications

High‐intensity focused ultrasound combined with hysteroscopic resection for the treatment of placenta accreta

High‐intensity focused ultrasound combined with hysteroscopic resection for the treatment of placenta accreta

Untitled

A rare case report of heterotopic cesarean scar pregnancy in the 8th week of gestation that was managed successfully by exploratory laparotomy with dilation and curettage

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