Evaluation of the treatment of high intensity focused ultrasound combined with suction curettage for exogenous cesarean scar pregnancy

Abstract

Purpose: To evaluate the effectiveness of high intensity focused ultrasound (HIFU) combined with suction curettage in the treatment of exogenous cesarean scar pregnancy (CSP).Methods: A total of 41 patients diagnosed with exogenous CSP were enrolled in this study. All patients received HIFU treatment combined with suction curettage.Results: Twenty-nine patients were administered one session of HIFU ablation. In addition, the other 12 patients received 2 HIFU sessions. Suction curettage was performed in all patients after HIFU, and no patient was converted to laparoscopy or hysterectomy. The mean blood loss during suction curettage was 99 ml. Three patients received two sessions of suction curettage. The success rate of our study was 92.68%. The mean time for serum β-HCG normalization was 23.18±3.13 days. The average menstruation recovery time was 29.38±3.34 days. Based on the blood loss during suction curettage, 41 patients were divided into a bleeding group and a control group. The size of the gestational sac in the bleeding group (3.80±0.87 cm) was larger than that in the control group (3.39±0.77 cm) (P <0.05). The thickness of the myometrium between the bladder and gestational sac in the bleeding group (2.37±0.89 mm) was less than that in the control group (2.75±0.75 mm) (P <0.05). Conclusion:The results suggested that HIFU combined with suction curettage could be considered an effective treatment for exogenous CSP of < 9 weeks. The size of the gestational sac and the thickness of the myometrium between the bladder and gestational sac might be high-risk factors for blood loss during this treatment.

Curative effect of high‐intensity focused ultrasound in management of different types of ectopic pregnancy: A systematic review

“…Regarding 305 CSP patients who were managed with HIFU‐S/C‐U, the mean and SD of hospital stay was 5.1 ± 2.01 days [20, 23]. Mu and Yuan did not report relevant data [21, 27].…”

“…Thermal injury is a complication directly related to the heat generated by HIFU. Although it is a reportedly common side effect, only 29 cases of our enrolled population reportedly presented with abnormal skin sensation rather than burn [10, 21, 27]. Other included studies did not report any relevant data.…”

“…Searching with our comprehensive terms initially yielded a total of 6637 studies, and their titles and abstracts were scrutinized for relevancy to our eligibility criteria. After excluding papers with irrelevant titles or abstracts, we scrutinized the full text of 36 papers and ultimately included a total of 17 studies for our SWiM [7][8][9][10][15][16][17][18][19][20][21][22][23][24][25][26][27]. Figure 1 resembled the PRISMA flow of our eligible studies.…”

“…According to the intervention, we categorized the included studies into HIFU monotherapy (88 patients) [7,9,25,26], HIFU combined with suction and curettage guided with hysteroscopy (HIFU-S/C-H) (262 patients) 68 -iRADIOLOGY F I G U R E 1 PRISMA flow chart. [10,[15][16][17][18][19], and HIFU combined with Suction and curettage guided with ultrasound (HIFU-S/C-U) (398 patients) [20,21,23,27].…”

“…All four studies that managed their 398 CSP patients with HIFU-S/C-U reported the time for β-HCG normalization; its mean and SD was 25.9 � 4.44 days [20,21,23,27].…”