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

• Published in: Journal of international medical research Vol. 40; no. 5; pp. 1919 - 1930
• Main Authors: Zhang, X-B, Zhong, Y-C, Chi, J-C, Shen, J-L, Qiu, X-X, Xu, J-R, Zhao, A-M, Di, W
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-10-2012
• Subjects: Adult; Cesarean Section; Chemoembolization, Therapeutic; Cicatrix; Combined Modality Therapy; Dilatation and Curettage; Female; Humans; Myometrium - diagnostic imaging; Myometrium - pathology; Pregnancy; Pregnancy, Ectopic - diagnostic imaging; Pregnancy, Ectopic - therapy; Treatment Outcome; Ultrasonography; Uterine Artery - pathology; Uterine Hemorrhage - therapy; Uterus - blood supply; Uterus - surgery; Young Adult; Caesarean scar pregnancy; Uterine artery chemoembolization; Dilation and curettage; Methotrexate
• ISSN: 0300-0605; 1473-2300
• DOI: 10.1177/030006051204000533

Objective:
This study investigated bilateral uterine artery chemo -embolization (BUACE) combined with dilation and curettage (D&C) in caesarean scar pregnancy (CSP).
Methods:
Nineteen women with CSP were referred for interventional radiology. In 13 patients, BUACE was performed before D&C, following a diagnosis of CSP. A further six patients received BUACE for massive vaginal bleeding after D&C for inevitable miscarriage; the diagnosis of CSP was subsequently confirmed ultrasonographically. BUACE of the uterine arteries was performed using gelfoam particles following intra-arterial infusion of 100 mg/m2 methotrexate.
Results:
BUACE was technically successful and immediate haemostasis was achieved in all patients. Blood loss was significantly greater during D&C undertaken before BUACE compared with D&C after BUACE, but this bleeding was controlled by BUACE. No patient required further surgical intervention and there were no severe complications. The gestational sac and placenta could no longer be detected ultrasonographically and the menstrual cycle returned to normal 2 - 3 months after treatment in all patients.
Conclusions:
BUACE followed by D&C seems to be a safe and effective treatment for CSP and should be considered as a treatment of choice.