Top

BMC Pregnancy and Childbirth

Published in:

Open Access 01-12-2021 | Sectio Ceasarea | Research

When to perform curettage after uterine artery embolization for cesarean scar pregnancy: a clinical study

Authors: Qiao Wang, Hongling Peng, Xia Zhao, Xiaorong Qi

Published in: BMC Pregnancy and Childbirth | Issue 1/2021

Abstract

Background

Prophylactic uterine artery embolization (UAE) combined with subsequent curettage is suggested as an effective and minimally invasive treatment strategy for cesarean scar pregnancy (CSP) with a high bleeding risk. However, the timing of curettage after UAE remains to be studied. Thus, we aimed to identify the optimal time interval to perform curettage after UAE in patients with CSP.

Methods

We conducted a retrospective cohort study in a large medical center for women and children in Southwest China. CSP patients treated by UAE combined with subsequent curettage were included and grouped by the treatment time interval between these two procedures. The clinical outcomes among arms were compared by univariate and multivariable analysis.

Results

Our study included 314 CSP patients who received this combination treatment in our department from January 2014 to December 2019. The median time interval between UAE and curettage was 48 h, with a range of 12-168 h among all participants. Thirty-two patients (10.2%) experienced intraoperative hemorrhage (blood loss ≥200 mL). Intrauterine balloon tamponade was used in 17 cases (5.4%). In 14 cases (4.5%), the procedure was converted to laparoscopy (or laparotomy). In the cohort study, patients with longer treatment intervals had more intraoperative blood loss and a higher incidence of complications than those with shorter intervals (P < 0.05). The rates of intraoperative bleeding were 5.0% for patients who received curettage within 24 h after UAE (Arm 1) and 19.4% for those who had a treatment interval longer than 72 h (Arm 4). In the multivariable logistic regression model of bleeding, a treatment interval > 72 h had an adjusted odds ratio of 3.37 (95% confidence interval: 1.40-8.09).

Conclusion

We suggest that curettage not be delayed longer than 72 h after UAE in this combined treatment of CSP.

Smfm MFM, Miller R, Timor-Tritsch IE, Gyamfi-Bannerman C. Society for Maternal-Fetal Medicine (SMFM) Consult Series #49: Cesarean scar pregnancy - ScienceDirect. Am J Obstet Gynecol. 2020;222(5):B2–14.CrossRef

Liu L, Ross WT, Chu AL, Deimling TA. An updated guide to the diagnosis and management of cesarean scar pregnancies. Curr Opin Obstet Gynecol. 2020;32(4):255–62. https://doi.org/10.1097/gco.0000000000000644.CrossRefPubMed

Glenn TL, Bembry J, Findley AD, Yaklic JL, Bhagavath B, Gagneux P, et al. Cesarean scar ectopic pregnancy: current management strategies. Obstet Gynecol Survey. 2018;73(5):293–302. https://doi.org/10.1097/ogx.0000000000000561.CrossRef

Birch Petersen K, Hoffmann E, Rifbjerg Larsen C, Svarre Nielsen H. Cesarean scar pregnancy: a systematic review of treatment studies. Fertil Steril. 2016;105(4):958–67. https://doi.org/10.1016/j.fertnstert.2015.12.130.CrossRefPubMed

Li X, Niu H, Li J, Zhang L, Qu Q. Clinical assessment of uterine artery embolization combined with curettage when treating patients with cesarean scar pregnancy: a retrospective study of 169 cases. J Obstet Gynaecol Res. 2020;46(7):1110–6. https://doi.org/10.1111/jog.14258.CrossRefPubMed

Qiu J, Fu Y, Xu J, Huang X, Yao G, Lu W. Analysis on clinical effects of dilation and curettage guided by ultrasonography versus hysteroscopy after uterine artery embolization in the treatment of cesarean scar pregnancy. Ther Clin Risk Manag. 2019;15:83–9. https://doi.org/10.2147/tcrm.S184387.CrossRefPubMedPubMedCentral

Li Y, Lu L, Wang W, Sun J, Zhang X, Huang X. Retrospective study of patients with cesarean scar pregnancies treated by uterine artery chemoembolization and curettage. Int J Gynaecol Obstet. 2018;143(2):172–7. https://doi.org/10.1002/ijgo.12636.CrossRefPubMed

Peng KW, Lei Z, Xiao TH, Jia FG, Zhong WX, Gao Y, et al. First trimester caesarean scar ectopic pregnancy evaluation using MRI. Clin Radiol. 2014;69:123–9.CrossRef

Fu LP. Therapeutic approach for the cesarean scar pregnancy. Medicine. 2018;97(18):e0476. https://doi.org/10.1097/md.0000000000010476.CrossRefPubMedPubMedCentral

10.

Ou J, Peng P, Li C, Teng L, Liu X. Assessment of the necessity of uterine artery embolization during suction and curettage for caesarean scar pregnancy: a prospective cohort study. BMC Pregnancy Childbirth. 2020;20(1):378. https://doi.org/10.1186/s12884-020-03062-z.CrossRefPubMedPubMedCentral

11.

Feng Y, Chen S, Li C, Zhang X, Duan H, Sooranna S, et al. Curettage after uterine artery embolization combined with methotrexate treatment for caesarean scar pregnancy. Exp Ther Med. 2016;12(3):1469–75. https://doi.org/10.3892/etm.2016.3489.CrossRefPubMedPubMedCentral

12.

Riaz RM, Williams TR, Craig BM, Myers DT. Cesarean scar ectopic pregnancy: imaging features, current treatment options, and clinical outcomes. Abdom Imaging. 2015;40(7):2589–99. https://doi.org/10.1007/s00261-015-0472-2.CrossRefPubMed

13.

Vial Y, Petignat P, Hohlfeld P. Pregnancy in a cesarean scar. Ultrasound Obstet Gynecol. 2000;16(4):592–3. https://doi.org/10.1046/j.1469-0705.2000.00300-2.x.CrossRefPubMed

14.

Chong Y, Zhang K, Zhou Y, Han J, Zhu F, Guo H, et al. Clinical value of MRI in cesarean scar pregnancy. Zhonghua fu chan ke za zhi. 2014;49(12):914–8.PubMed

15.

Wang Q, Ma H, Peng H, He L, Bian C, Zhao C. Risk factors for intra-operative haemorrhage and bleeding risk scoring system for caesarean scar pregnancy: a case–control study. Eur J Obstet Gynecol Reprod Biol. 2015;195:141–5.CrossRef

16.

Cao GS, Liu RQ, Liu YY, Liu JW, Li LP, Zhang Q, et al. Menstruation recovery in scar pregnancy patients undergoing UAE and curettage and its influencing factors. Medicine. 2018;97(11):e9584. https://doi.org/10.1097/md.0000000000009584.CrossRefPubMedPubMedCentral

17.

Gao L, Hou YY, Sun F, Xia W, Yang Y, Tian T, et al. A retrospective comparative study evaluating the efficacy of adding intra-arterial methotrexate infusion to uterine artery embolisation followed by curettage for cesarean scar pregnancy. Arch Gynecol Obstet. 2018;297(5):1205–11. https://doi.org/10.1007/s00404-018-4686-8.CrossRefPubMed

18.

Hong Y, Guo Q, Pu Y, Lu D, Hu M. Outcome of high-intensity focused ultrasound and uterine artery embolization in the treatment and management of cesarean scar pregnancy: a retrospective study. Medicine. 2017;96(30):e7687. https://doi.org/10.1097/md.0000000000007687.CrossRefPubMedPubMedCentral

19.

Chen H, Zhou J, Wang H, Tan W, Yao M, Wang X. The treatment of cesarean scar pregnancy with uterine artery embolization and curettage as compared to Transvaginal Hysterotomy. Eur J Obstet Gynecol Reprod Biol. 2017;214:44–9. https://doi.org/10.1016/j.ejogrb.2017.04.032.CrossRefPubMed

20.

Qiao B, Zhang Z, Li Y. Uterine artery embolization versus methotrexate for cesarean scar pregnancy in a Chinese population: a meta-analysis. J Minim Invasive Gynecol. 2016;23(7):1040–8. https://doi.org/10.1016/j.jmig.2016.08.819.CrossRefPubMed

21.

Ko HK, Shin JH, Ko GY, Gwon DI, Kim JH, Han K, et al. Efficacy of prophylactic uterine artery embolization before obstetrical procedures with high risk for massive bleeding. Korean J Radiol. 2017;18(2):355–60. https://doi.org/10.3348/kjr.2017.18.2.355.CrossRefPubMedPubMedCentral

22.

Sun QL, Wu XH, Luo L, Ying DM, Yang Y, Chen ZQ. Characteristics of women with mixed mass formation after evacuation following uterine artery chemoembolization for cesarean scar pregnancy. Arch Gynecol Obstet. 2018;297(4):1059–66. https://doi.org/10.1007/s00404-018-4716-6.CrossRefPubMed

23.

Du YJ, Zhang XH, Wang LQ. Risk factors for Haemorrhage during suction curettage after uterine artery embolization for treating caesarean scar pregnancy: a case-control study. Gynecol Obstet Investig. 2015;80(4):259–64. https://doi.org/10.1159/000381263.CrossRef

Title: When to perform curettage after uterine artery embolization for cesarean scar pregnancy: a clinical study
Authors: Qiao Wang
Hongling Peng
Xia Zhao
Xiaorong Qi
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Sectio Ceasarea
Sectio Caesarea
Published in: BMC Pregnancy and Childbirth / Issue 1/2021
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-021-03846-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

When to perform curettage after uterine artery embolization for cesarean scar pregnancy: a clinical study

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

Paternal factors and adverse birth outcomes in Lanzhou, China

Why do pregnant women prefer cesarean birth? A qualitative study in a tertiary care center in Southern Thailand

Letter to the Editor in response to ‘Parental attachment and depressive symptoms in pregnancies complicated by twin-twin transfusion syndrome: a cohort study’

Progress towards Every Newborn Action Plan (ENAP) implementation in Iran: obstacles and bottlenecks

Predictors and occurrence of antenatal depressive symptoms in Galle, Sri Lanka: a mixed-methods cross-sectional study

What stakeholders think: perceptions of perinatal depression and screening in China’s primary care system