Curettage after uterine artery embolization combined with methotrexate treatment for caesarean scar pregnancy

Feng,Ying; Chen,Suwen; Li,Changdong; Zhang,Xiaofeng; Duan,Hua; Sooranna,Suren; Johnson,Mark  R.; Li,Jian

doi:10.3892/etm.2016.3489

Curettage after uterine artery embolization combined with methotrexate treatment for caesarean scar pregnancy

Authors:
- Ying Feng
- Suwen Chen
- Changdong Li
- Xiaofeng Zhang
- Hua Duan
- Suren Sooranna
- Mark R. Johnson
- Jian Li
View Affiliations

Affiliations: Department of Gynaecology, Beijing Obstetrics and Gynaecology Hospital, Capital Medical University, Beijing 100026, P.R. China, Department of Gynaecology, Imperial College London, Chelsea and Westminster Hospital, London SW10 9NH, UK
Published online on: June 29, 2016 https://doi.org/10.3892/etm.2016.3489
Pages: 1469-1475
Copyright: © Feng et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

In the present study, we evaluated the diagnosis and management modalities of caesarean scar pregnancy (CSP). Thirty patients diagnosed with CSP were retrospectively studied between February, 2010 and February, 2012. Twenty-five patients were offered prophylactic uterine artery embolization (UAE) and methotrexate (MTX) prior to uterine suction curettage. Five cases were referred from other hospitals where the initial management with uterine suction curettage had resulted in uncontrollable massive haemorrhage, 4 of the cases had UAE and one proceeded immediately to hysterectomy. In the 25 patients treated with prophylactic UAE and MTX, 12 had laparoscopy-guided curettage and 13 had ultrasound-guided curettage without complication. The results showed that the 25 patients with CSP, who received prophylactic UAE and MTX prior to uterine curettage, recovered without complications. Five patients referred from other hospitals, where uterine curettage was the primary procedure, had severe complications including uncontrolled vaginal bleeding and uterine rupture. Four of the five patients were treated successfully with emergency UAE and the remaining patient underwent emergency hysterectomy as ultrasound examination detected significant haemorrhage between the uterus and the bladder. Of the 25 patients who received prophylactic UAE combined with MTX, there were no reports of irregular menstruation or serious adverse effects. Notably, the decrease in serum human chorionic gonadotropin (HCG) levels 3 days post‑surgery was greater with ultrasound-guided curettage (84.3±5.5%) than with laparoscopy-guided curettage (76.3±10.2%). In summary, the data suggested that prophylactic UAE with MTX followed by ultrasound-guided curettage is the most effective therapeutic approach in CSP.

View Figures

View References

1	Larsen JV and Solomon MH: Pregnancy in a uterine scar sacculus: an unusual case of postabortal hemorrhage. S Afr Med. 53:142–143. 1978.
2	Tinelli A, Tinelli R and Malvasi A: Laparoscopic management of cervical-isthmic pregnancy: a proposal method. Fertil Steril. 92:829.e3–829.e6. 2009. View Article : Google Scholar
3	Zhang B, Jiang ZB, Huang MS, Guan SH, Zhu KS, Qian JS, Zhou B, Li MA and Shan H: Uterine artery embolization combined with methotrexate in the treatment of cesarean scar pregnancy: results of a case series and review of the literature. J Vasc Interv Radiol. 23:1582–1588. 2012. View Article : Google Scholar : PubMed/NCBI
4	Köroğlu M, Kayhan A, Soylu FN, Erol B, Schmid-Tannwald C, Gürses C, Karademir İ, Ernst R, Yousuf A and Oto A: MR imaging of ectopic pregnancy with an emphasis on unusual implantation sites. Jpn J Radiol. 31:75–80. 2013. View Article : Google Scholar : PubMed/NCBI
5	Seow KM, Huang LW, Lin YH, Lin MY, Tsai YL and Hwang JL: Cesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol. 23:247–253. 2004. View Article : Google Scholar : PubMed/NCBI
6	Maymon R, Halperin R, Mendlovic S, Schneider D, Vaknin Z, Herman A and Pansky M: Ectopic pregnancies in Caesarean section scars: the 8 year experience of one medical centre. Hum Reprod. 19:278–84. 2004. View Article : Google Scholar : PubMed/NCBI
7	Sadeghi H, Rutherford T, Rackow BW, Campbell KH, Duzyj CM, Guess MK, Kodaman PH and Norwitz ER: Cesarean scar ectopic pregnancy: case series and review of the literature. Am J Perinatol. 27:111–120. 2010. View Article : Google Scholar : PubMed/NCBI
8	Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R and Elson CJ: First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment Cesarean section scar. Ultrasound Obstet Gynecol. 21:220–227. 2003. View Article : Google Scholar : PubMed/NCBI
9	Zhuang Y and Huang L: Uterine artery embolization compared with methotrexate for the management of pregnancy implanted within a cesarean scar. Am J Obstet Gynecol. 201:152.e1–152.e3. 2009. View Article : Google Scholar
10	Sugawara J, Senoo M, Chisaka H, Yaegashi N and Okamura K: Successful conservative treatment of a cesarean scar pregnancy with uterine artery embolization. Tohoku J Exp Med. 206:261–265. 2005. View Article : Google Scholar : PubMed/NCBI
11	Fylstra DL: Ectopic pregnancy within a cesarean scar: a review. Obstet Gynecol Surv. 57:537–543. 2002. View Article : Google Scholar : PubMed/NCBI
12	Ash A, Smith A and Maxwell D: Caesarean scar pregnancy. BJOG. 114:253–263. 2007. View Article : Google Scholar : PubMed/NCBI
13	Wang CB and Tseng CJ: Primary evacuation therapy for Cesarean scar pregnancy: three new cases and review. Ultrasound Obstet Gynecol. 27:222–226. 2006. View Article : Google Scholar : PubMed/NCBI
14	McKenna DA, Poder L, Goldman M and Goldstein RB: Role of sonography in the recognition, assessment, and treatment of cesarean scar ectopic pregnancies. J Ultrasound Med. 27:779–783. 2008.PubMed/NCBI
15	Maymon R, Halperin R, Mendlovic S, Schneider D and Herman A: Ectopic pregnancies in a Caesarean scar: review of the medical approach to an iatrogenic complication. Hum Reprod Update. 10:515–523. 2004. View Article : Google Scholar : PubMed/NCBI
16	Vial Y, Petignat P and Hohlfeld P: Pregnancy in a cesarean scar. Ultrasound Obstet Gynecol. 16:592–593. 2000. View Article : Google Scholar : PubMed/NCBI
17	Ben Nagi J, Ofili-Yebovi D, Marsh M and Jurkovic D and Jurkovic D: First-trimester cesarean scar pregnancy evolving into placenta previa/accreta at term. J Ultrasound Med. 24:1569–1573. 2005.PubMed/NCBI
18	Osborn DA, Williams TR and Craig BM: Cesarean scar pregnancy: sonographic and magnetic resonance imaging findings, complications, and treatment. J Ultrasound Med. 31:1449–1456. 2012.PubMed/NCBI
19	Wang YL, Su TH and Chen HS: Laparoscopic management of an ectopic pregnancy in a lower segment cesarean section scar: a review and case report. J Minim Invasive Gynecol. 12:73–79. 2005. View Article : Google Scholar : PubMed/NCBI
20	Wu X, Zhang X, Zhu J and Di W: Caesarean scar pregnancy: comparative efficacy and safety of treatment by uterine artery chemoembolization and systemic methotrexate injection. Eur J Obstet Gynecol Reprod Biol. 161:75–79. 2012. View Article : Google Scholar : PubMed/NCBI
21	Jiao LZ, Zhao J, Wan XR, Liu XY, Feng FZ, Ren T and Xiang Y: Diagnosis and treatment of cesarean scar pregnancy. Chin Med Sci J. 23:10–15. 2008. View Article : Google Scholar : PubMed/NCBI
22	Akbayir O, Gedikbasi A, Akyol A, Ucar A, Saygi-Ozyurt S and Gulkilik A: Cesarean scar pregnancy: a rare cause of uterine arteriovenous malformation. J Clin Ultrasound. 39:534–538. 2011. View Article : Google Scholar : PubMed/NCBI
23	Liang F and He J: Methotrexate-based bilateral uterine arterial chemoembolization for treatment of cesarean scar pregnancy. Acta Obstet Gynecol Scand. 89:1592–1594. 2010. View Article : Google Scholar : PubMed/NCBI
24	Jander HP and Russinovich NA: Transcatheter gelfoam embolization in abdominal, retroperitoneal, and pelvic hemorrhage. Radiology. 136:337–344. 1980. View Article : Google Scholar : PubMed/NCBI