Uterine artery embolization combined with ultrasound-guided dilation and curettage for the treatment of cesarean scar pregnancy: Efficacy and 5–8-year follow-up study

Gu, Zhuxin; Jia, Pengfei; Gao, Ziyang; Gu, Weiwei; Zhao, Hui; Zhao, Sumin

doi:10.1016/j.jimed.2022.03.006

Cited by 4 publications

(3 citation statements)

References 21 publications

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“…Devascularization of uterus was achieved. This gave us confidence of avoiding a torrential hemorrhage during further surgical procedure [3].…”

Section: Discussionmentioning

confidence: 85%

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Conservative surgical management of a heterotopic scar pregnancy: A case report

Desai,

Mutatkar

2023

J Case Rep Images Obstet Gynecol

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Introduction: The cesarean scar pregnancy is on rise and the objective of this case study is to highlight a different, bold but conservative approach to an unusual challenging case of eight weeks heterotopic cesarean scar pregnancy, which was threatening to rupture. Case Report: A 31-year-old G3P2L1 previous two cesarean sections presented with lower abdominal pain and bleeding. She was hemodynamically stable, and ultrasonography (USG) and magnetic resonance imaging (MRI) revealed heterotopic pregnancy, eight weeks (gestational sacs > 32 mm) intrauterine and caesarean scar pregnancy, which was threatening to rupture. Since the scar pregnancy was large, BHcG was > 200,000 iu, there was evidence of imminent scar dehiscence; and she was stable and had good blood parameters. The authors decided to take cautious but bold decision of suction evacuation under USG guidance, following the uterine artery embolism. The procedure was smooth and lower segment scar sacculus bleeding was controlled by compression with help of Foley’s balloons inside uterine cavity as well as in bladder. There was no evidence of extrauterine bleeding. She made a good post-operative recovery. Follow-ups consisted of serial BHcG and USG to monitor the regress. Conclusion: This case study implies that cesarean scar pregnancy, even with imminent scar dehiscence can be managed by USG-guided suction evacuation by experienced hands. Prior uterine artery embolization (UAE) added the safety of bleeding control. This case also emphasizes the importance of a patient monitoring and relying on failing BHcG, and a symptom free patient; and not on mass in CS scar alone which was slow to resolve.

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“…Devascularization of uterus was achieved. This gave us confidence of avoiding a torrential hemorrhage during further surgical procedure [3].…”

Section: Discussionmentioning

confidence: 85%

“…The couple were counseled for this conservative surgical approach [3,4] of suction evacuation after devascularization with uterine artery embolization (UAE). They were explained about the uncertainty of the result; however, the couple accepted this procedure with full understanding.…”

Section: Procedures Onmentioning

confidence: 99%

Conservative surgical management of a heterotopic scar pregnancy: A case report

Desai,

Mutatkar

2023

J Case Rep Images Obstet Gynecol

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“…Increasing evidence suggests that UAE can be minimally invasive in CSP in that it can be performed with laparoscopy, hysteroscopy, or local resection [ 8 , 9 ]. UAE preconditioning can effectively block blood vessels, thus greatly reducing the risk of bleeding and preserving normal reproductive function [ 10 ]. However, the incidence of adverse events is reported to be 8.0–51.7% [ 11 ], commonly including large-area uterine necrosis, postoperative pain, bladder or rectum necrosis, premature ovarian failure, and postembolization amenorrhea [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and safety of prophylactic abdominal aortic balloon occlusion for patients with type III caesarean scar pregnancy: a prospective cohort study

Wu,

Guo,

et al. 2023

BMC Pregnancy Childbirth

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Background Caesarean scar pregnancy (CSP) is a special type of ectopic pregnancy with a high risk of massive haemorrhage. Few studies have focused on the efficacy of prophylactic abdominal aortic balloon occlusion as a minimally invasive method in caesarean section. This study aimed to evaluate the effectiveness and safety of prophylactic abdominal aortic balloon occlusion for patients with type III CSP. Methods This was a prospective cohort study. Patients with type III CSP in the First Affiliated Hospital of Zhengzhou University from January 2020 to June 2022 were enrolled. Eligible patients received prophylactic abdominal aortic balloon occlusion (defined as the AABO group) or uterine artery embolization (defined as the UAE group) before laparoscopic surgery. Clinical outcomes included intraoperative blood loss, body surface radiation dose, hospitalization expenses, and time to serum β-hCG normalization, and safety were also assessed. Results A total of 68 patients met the criteria for the study, of whom 34 patients were in the AABO group and 34 patients were in the UAE group. The median intraoperative blood loss in the AABO and UAE groups was 17.5 (interquartile ranges [IQR]: 10, 45) and 10 (IQR: 6.25, 20) mL, respectively (P = 0.264). The body surface radiation dose of the AABO group was much lower than that of the UAE group (5.22 ± 0.44 vs. 1441.85 ± 11.59 mGy, P < 0.001). The AABO group also had lower hospitalization expenses than the UAE group (2.42 ± 0.51 vs. 3.42 ± 0.85 *10^5 yuan, P < 0.001). The average time to serum β-hCG normalization in the AABO group was 28.9 ± 3.21 d, which was similar to that in the UAE group (30.3 ± 3.72 d, P = 0.099). In addition, the incidence of adverse events in the AABO group was lower than that in the UAE group (5.9% vs. 58.8%, P < 0.001). Conclusion Prophylactic AABO was equally as effective as UAE in patients with type III CSP but was safer than UAE during and after the operation.

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