Retrospective study of patients with cesarean scar pregnancies treated by uterine artery chemoembolization and curettage

Li, Yang; Lu, Lingjia; Wang, Wenxian; Sun, Jin Gyu; Zhang, Xinmei; Huang, Xiufeng

doi:10.1002/ijgo.12636

Cited by 19 publications

(20 citation statements)

References 20 publications

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“…A total of 358 articles were identified; 122 were assessed with respect to their eligibility for inclusion and 44 studies were included in the systematic review (Table 1, Figure 1). 9,10,21‐61 These studies included 3598 women with a prior CSP; of these, information on subsequent pregnancy was available for 592 women.…”

Section: Resultsmentioning

confidence: 99%

Reproductive outcome after cesarean scar pregnancy: A systematic review and meta‐analysis

Morlando

Buca

Timor‐Tritsch

et al. 2020

Acta Obstet Gynecol Scand

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Introduction To evaluate subsequent reproductive among women with a prior cesarean scar pregnancy (CSP). Material and methods MEDLINE, Embase and ClinicalTrials.gov databases were searched. Inclusion criteria were women with a prior CSP, defined as the gestational sac or trophoblast within the dehiscence/niche of the previous cesarean section scar or implanted on top of it. The primary outcome was the recurrence of CSP; secondary outcomes were the chance of achieving a pregnancy after CSP, miscarriage, preterm birth, uterine rupture and the occurrence of placenta accreta spectrum disorders. Subgroup analysis according to the management of CSP (surgical vs non‐surgical) was also performed. Random effect meta‐analyses of proportions were used to analyze the data. Results Forty‐four studies (3598 women with CSP) were included. CSP recurred in 17.6% of women. Miscarriage, preterm birth and placenta accreta spectrum disorders complicated 19.1% (65/341), 10.3% (25/243) and 4.0% of pregnancies, and 67.0% were uncomplicated. When stratifying the analysis according to the type of management, CSP recurred in 21% of women undergoing surgical and in 15.2% of those undergoing non‐surgical management. Placenta accreta spectrum disorders complicated 4.0% and 12.0% of cases, respectively. Conclusions Women with a prior CSP are at high risk of recurrence, miscarriage, preterm birth and placenta accreta spectrum. There is still insufficient evidence to elucidate whether the type of management adopted (surgical vs non‐surgical) can impact reproductive outcome after CSP. Further large, prospective studies sharing an objective protocol of prenatal management and long‐term follow up are needed to establish the optimal management of CSP and to elucidate whether it may affect its risk of recurrence and pregnancy outcome in subsequent gestations.

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Section: Resultsmentioning

confidence: 99%

Reproductive outcome after cesarean scar pregnancy: A systematic review and meta‐analysis

Morlando

Buca

Timor‐Tritsch

et al. 2020

Acta Obstet Gynecol Scand

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“…Uterine artery embolization, which has been widely used in controlling hemorrhage in gynecology and obstetrics, is regarded as a good option of treating CSP with minimal invasion, especially when used as an adjuvant therapy with other surgical treatment such as curettage. There have been dozens of studies evaluating the e cacy and safety of UAE used in CSP treatment, either as a single therapy or combined with other methods [5][6][7][8][9][10][14][15][16][17][18][19]. However, there is currently no study pointing out the optimal timing to perform surgical treatment after prophylactic UAE.…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…The management should be individualized [4]. According to previous studies, adjuvant uterine artery embolization (UAE) combined with following curettage (including dilatation and curettage or vacuum aspiration) was suggested as an effective and minimally invasive treatment strategy for CSP patients with high bleeding risk [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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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Cesarean Scar Pregnancies Treated by Uterine Artery Chemotherapy Embolization Combined With Ultrasound‐Guided Dilation and Curettage

Zheng

Chen

et al. 2022

J of Ultrasound Medicine

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Objectives To explore the effect of cesarean scar pregnancy (CSP) treatment by comparing uterine artery chemotherapy embolization (UACE) combined with dilation and curettage (D&C) with or without ultrasound guidance. Methods CSP patients treated with UACE combined with D&C from January 2013 to December 2020 at Shuguang Hospital, affiliated to Shanghai University of Traditional Chinese Medicine were included in this retrospective study. The patients were divided into groups A and B according to whether D&C was guided by ultrasound. Results Forty‐eight patients with CSP diagnosed by transvaginal ultrasound were included in this study, whose gestational age was <8 weeks. There were no significant differences in the basic clinical characteristics of the two groups. The success rates of the 2 groups were no significant difference, 100% (27/27) in group A and 85.7% (18/21) in group B. The maximal intraoperative blood loss of group A was 100 mL and that of group B was 150 mL. There was no uterine perforation during the operation. Ultrasound guidance can shorten the D&C operation time, reduce intraoperative bleeding during D&C, and decrease the residual rate of trophoblastic tissue after D&C. Conclusions Ultrasound guidance can improve the safety and efficiency of UACE combined with D&C in the treatment of CSP and reduce its complications. We believe it is an optimal treatment for CSP patients who do not plan to have children in the future.

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Retrospective study of patients with cesarean scar pregnancies treated by uterine artery chemoembolization and curettage

Abstract: UACE combined with curettage was found to be an effective fertility-sparing treatment for CSP. Further, the approach did not seem to harm future reproductive ability.

Cited by 19 publications

References 20 publications

Reproductive outcome after cesarean scar pregnancy: A systematic review and meta‐analysis

Reproductive outcome after cesarean scar pregnancy: A systematic review and meta‐analysis

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

Cesarean Scar Pregnancies Treated by Uterine Artery Chemotherapy Embolization Combined With Ultrasound‐Guided Dilation and Curettage

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