Pituitrin local injection versus uterine artery embolization in the management of cesarean scar pregnancy: A retrospective cohort study

Abstract

Aim To compare the effect of pituitrin local injection (PIT) and uterine artery embolization (UAE) as pretreatment before surgery during the management of cesarean scar pregnancy (CSP). Methods Forty‐nine CSP patients diagnosed in our department of Suzhou Ninth People's Hospital from October 2017 to October 2019. All patients underwent hysteroscopy and negative pressure aspiration (for type I CSP) or laparoscopic wedge‐resection (for type II and III CSP) following one of the preoperative treatments: PIT group (n = 26) and UAE group (n = 23). The baseline clinical data, intraoperative blood loss, blood transfusion rate, postoperative hospital stay, hospitalization expenses, postoperative pain, postoperative fever, postoperative serum β‐human chorionic gonadotropin (β‐hCG) level, and pregnancy outcome were reviewed and analyzed. Results There was no significant difference (p ≥ 0.05) between two groups in baseline characteristics including age, gravidity, previous cesarean section times, interval since last cesarean delivery, menolipsis time, maximum diameter of gestational sac or mass under ultrasound, fetal cardiac activity and preoperative β‐hCG level. There was no significant difference in blood loss, transfusion rate, and postoperative β‐hCG reduction percentage (p ≥ 0.05) either. The postoperative hospital stay, hospitalization expenses, postoperative pain, and postoperative fever rate in PIT group were significantly lower than those in UAE group (p < 0.05). Moreover, β‐hCG level of all patients turned negative 1 month after surgery successfully. Conclusions PIT pretreatment seems to be a same effective, more economical, and with fewer side effects pretreatment method compared to traditional UAE pretreatment in the management of CSP.

Treatment of Cesarean Scar Ectopic Pregnancy in China with Uterine Artery Embolization—A Systematic Review and Meta-Analysis

“…UAE may be used alone or combined with local or systemic MTX for treatment of CSP. Moreover, it can be performed before uterine D&C, laparoscopy, hysteroscopy, or local resection [13][14][15][16].…”

Outcomes of prophylactic lauromacrogol injection versus non-injection in patients with endogenous cesarean scar pregnancy treated by hysteroscopic surgery: a retrospective cohort study

“…Chen et al [ 19 ] reported that the value of prophylactic UAE during hysteroscopy in patients with type II CSP was uncertain. Wang et al [ 20 ] found that, compared with UAE pretreatment in the treatment of CSP, the pretreatment with local pituitrin injection appears to be the same: effective, more economical, and with fewer side effects.…”

A combination of laparoscopy and bilateral uterine artery occlusion for the treatment of type II cesarean scar pregnancy: a retrospective analysis

“…2 However, over the past 10 years, the incidence of CSP has increased rapidly, owing to the increase in the number of cesarean sections being performed worldwide, and especially in mainland China, with the introduction of the two-child policy. 3 CSP can be categorized as type I (endogenic), characterized by growth toward the uterine cavity, and type II (exogenic), characterized by deep invasion of the uterine defect across the uterine serosa and toward the bladder and abdominal cavity. 4 If it is not diagnosed and treated early, type II CSP can result in uncontrollable hemorrhage, uterine rupture, damage to surrounding organs, and hysterectomy, which have negative effects on the reproductive health and lives of women.…”

“…2 However, over the past 10 years, the incidence of CSP has increased rapidly, owing to the increase in the number of cesarean sections being performed worldwide, and especially in mainland China, with the introduction of the two-child policy. 3…”