High‐intensity focused ultrasound compared with uterine artery chemoembolization with methotrexate for the management of cesarean scar pregnancy

Abstract

Objective To compare the effectiveness and safety of high‐intensity focused ultrasound (HIFU) versus uterine artery chemoembolization with methotrexate for the management of cesarean scar pregnancy (CSP). Methods A total of 170 women with CSP were enrolled in the retrospective cohort study from April 2016 to September 2020. One hundred women received HIFU followed by suction curettage, and 70 women were treated with uterine artery chemoembolization followed by suction curettage. Results The median blood loss during suction curettage was 20 ml (range 2–800 ml) in the HIFU group versus 20 ml (range 5–200 ml) in the chemoembolization group (P = 0.837). The mean time for β‐human chorionic gonadotropin normalization was 28.52 ± 10.82 days versus 26.69 ± 8.97 days (P = 0.246), respectively. The mean time of menstruation recovery was 34.36 ± 10.63 days versus 31.93 ± 8.53 days (P = 0.114), respectively. The incidence of adverse effects in the HIFU group was lower than that in the chemoembolization group (P = 0.028). The median hospitalization time in the HIFU group was longer than that in the chemoembolization group (P = 0.000). Conclusion HIFU was as effective and safe as uterine artery chemoembolization in the management of CSP, and the incidence of adverse effects was lower.

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 ].…”

“…Interestingly, although HIFU was associated with a lower incidence of minor complications, the overall hospital stay was longer compared with patients who underwent endovascular embolization [ 31 ]. Overall, the most commonly occurring adverse effect of the treatment was lower abdominal pain [ 25 ].…”

Treatment of Placenta Increta With High-Intensity Focused Ultrasound Ablation and Leaving the Placenta in situ: A Multicenter Comparative Study

“…“Leaving the placenta in situ ” can successfully preserve the uterus and avoid hysterectomy in the majority of patients without any major bleeding, but there is still a risk of infection and bleeding, and whether residual placenta mechanization will affect later pregnancy is still a clinical concern. Focused ultrasound therapy is a non-invasive treatment technique that has been widely used in the clinical treatment of many diseases in recent years, and it has achieved satisfactory clinical outcomes ( 15 – 19 ). The HIFU ablation technique is used for the treatment of placenta increta, which is based on the strategy of “leaving the placenta in situ ,” where HIFU ablation causes in situ necrosis of the residual placental tissue, vascular blockage, peeling off of the necrotic tissue, and reduction in the number of medical operations, such as curettage.…”

An update and review of nontubal ectopic pregnancy management

“…Several recent studies have evaluated the efficacy of high intensity focused ultrasound (HIFU) ablation for the treatment of CSEP [34,35 ▪ ,36,37]. HIFU uses 350–400 W of acoustic power to induce coagulative necrosis in the targeted tissue.…”