2014, Volume 16, Issue 5
Strategic Study of CAE >> 2014, Volume 16, Issue 5
Curettage after uterine artery embolization combined with methotrexate treatment for caesarean scar pregnancy
Department of Gynaecology，Beijing Obstetrics and Gynaecology Hospital，Capital Medical University，Beijing 100006，China
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Abstract
To evaluate the effect of curettage after uterine artery embolization and methotrexate（UACE）treatment for caesarean scar pregnancy（CSP）. A retrospective study on 140 pa-tients diagnosed with CSP between February 2003 to April 2013 at Beijing Obstetrics and Gynaecology Hospital was carried out. 35 patients between February 2003 to March 2010 were offered systemic chemotherapy and local injection with methotrexate（MTX）prior to uterine suction curettage. 105 patients between April 2010 to April 2013 were offered prophylactic UACE prior to uterine suction curettage with using ultrasound/hysteroscopy/laparoscopy- guided uterine curettage. The operation time，blood loss，uterine retention rate，hospitalization days serum beta-HCG，menstrual recover，serious adverse effect and medical expense of two groups were recorded and compared. The results show that among 140 cases of CSP，108 cases were diagnosed in our hospital by transabdominal ultrasound and transvaginal ultrasound exactly. 3 cases were misdiagnosed in our hospital. 32 cases were referred from other hospitals where the initial management with uterine suction curettage had resulted in uncontrollable massive haemorrhage.In MTX group，33 patients with CSP recovered without complications and 2 patients underwent emergency hysterectomy for massive haemorrhage. In UACE group，100 patients were treated successfully with UACE. Three patients were received second UACE as uncontrolled massive vaginal hemorrhage. No significant difference in preoperative indicators was found between two groups including average age，menopause time，gestational sac diameter and β —HCG levels.But after the operation，we found significant difference between MTX group and UACE group in uterine retention rates. The significant differences were also observed in the amount of vaginal bleeding during uterine suction curettage：average hospitalization days，average resume time in β—HCG levels and medical expense between MTX group and UACE group. No treatmentrelated complications occurred in long-term observation in neither of the groups. Based observing our patients，it appears that ultrasound- guided curettage after uterine artery embolization combined with methotrexate may be an effective means of treatment for caesarean scar pregnancy.
Keywords
CSP ; UACE ; MTX ; suction curettage
References
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