Uterine artery embolisation combined with local methotrexate for treatment of caesarean scar pregnancy

Abstract

Objective The aim of the study was to determine the efficacy of uterine artery embolisation (UAE) combined with local methotrexate (MTX) for the treatment of caesarean scar pregnancy, compared with other traditional modalities, and to investigate the complications associated with this treatment.Design A retrospective cohort study.Setting A large obstetrics and gynaecology unit within a university hospital in China.Sample Women who were diagnosed with a caesarean scar pregnancy between January 2003 and December 2008, and who had informative case records, were included in the study.Methods We reviewed the results for all women who received one of three treatments: dilation and curettage (D&C) (11 patients; group A), systemic MTX (17 patients; group B), and UAE and local MTX (38 patients; group C).Main outcome measures The main outcome measures were success rate, blood loss, time for b human chorionic gonadotrophin (b-hCG) to decline to normal values, and the duration of hospital stay. Success was defined as a complete recovery with no severe complications and with the preservation of fertility.Results A total of 66 women diagnosed with caesarean scar pregnancy between January 2003 and December 2008 were identified, and their data were analysed. The success rate in group C was significantly higher than that in groups A and B after adjusting for b-hCG level (89.5 versus 27.3 and 58.8%, respectively; P < 0.001). The mean blood loss in group C was lower than in the other two groups (240.5 versus 855.5 and 639.4 ml, respectively; P = 0.008 and 0.009, respectively). The average time for b-hCG to decline to normal values was significantly shorter in group C than in group B (28.1 versus 44.3 days; P = 0.021). A significantly shorter duration of hospital stay was observed in group C compared with group B (12.5 versus 22.0 days; P = 0.024).Conclusions UAE combined with local MTX is of benefit to women wishing to preserve fertility, and is suitable for use as the primary treatment for caesarean scar pregnancy.Keywords Caesarean scar pregnancy, dilation and curettage, morbidity, systemic methotrexate, uterine artery embolisation.

Caesarean Scar Pregnancy: Treatment with Bilateral Uterine Artery Chemoembolization Combined with Dilation and Curettage

“…Only three women were successfully treated without severe complications and with preservation of the uterus; the other eight women were treated with hysterectomy or wedge excision of the uterus. 18 In the present study, all the patients in group B were successfully treated with BUACE and did not require more invasive surgical procedures.…”

“…The dose (100 mg/m 2 ) was higher than that previously reported in the literature. 18 Use of a higher dose speeds up the necrosis of the gestational sac, enabling complete resolution to occur before the gelfoam particles are absorbed. The uterine artery was embolized immediately after MTX infusion using gelfoam particles to maintain a relatively high local MTX concentration.…”

Uterine artery embolization with methotrexate infusion as treatment for cesarean scar pregnancy. Case report

“…Thus, such countries need to acquire knowledge about new targets for effective treatment. The UAE technique used in association with intra-arterial MTX infusion was first described by Yang et al [9]. Their intention was to infuse the chemotherapy through the uterine arteries and not directly into the gestational sac or surrounding endometrium, which could cause scar rupture and extensive hemorrhaging.…”

Caesarean Scar Pregnancy - A Rare Case Report

“…Strict imaging criteria must be used in performing the diagnosis-an empty uterus, empty cervical canal, development of the sac in the anterior part of the isthmic portion and an absence of healthy myometrium between the bladder wall and the gestational sac. A retrospective cohort study was done in University hospital in China to determine the efficacy of Uterine Artery Embolisation (UAE) combined with local Methotrexate (MTX) for the treatment of Caesarean scar pregnancy between Jan 2003 and Dec 2008 and they concluded that UAE with local MTX is of benefit to women wishing to preserve fertility, and is suitable for use as a primary treatment of caesarean scar pregnancy 26 . Because of difficult diagnosis and probably delayed treatment this patient developed complication resulting extended surgery with loss of fertility.…”