Top

Archives of Gynecology and Obstetrics

Published in:

01-07-2016 | Maternal-Fetal Medicine

Uterine artery embolization combined with curettage vs. methotrexate plus curettage for cesarean scar pregnancy

Authors: Wei Liu, Liang Shen, Qingwen Wang, Wei Wang, Zengtao Sun

Published in: Archives of Gynecology and Obstetrics | Issue 1/2016

Abstract

Purpose

To compare the efficacy and safety of uterine artery embolization (UAE) combined with curettage and methotrexate (MTX) plus curettage in the treatment of cesarean scar pregnancy (CSP).

Methods

From January 2005 to December 2013, we treated 38 CSP patients with UAE combined with curettage, and another 26 patients with CSP were treated with methotrexate (MTX) plus curettage. The resulting data were analyzed statistically.

Results

The median volume of blood loss was 17.5 ml in the UAE combined with curettage (UAE-C) group vs. 335 ml in the MTX plus curettage (MTX-C) group (p < 0.001). The time from the procedure till β-human chorionic gonadotropin (β-hCG) concentration returned to normal was 25.13 ± 3.74 days in the UAE-C group vs. 56.15 ± 15.99 days in the MTX-C group (p < 0.001). The duration of hospitalization was 7.44 ± 1.92 vs. 19.38 ± 8.75 days, respectively (p < 0.001). The percentage of side effects in the UAE-C group was significantly lower than in the MTX-C group.

Conclusions

UAE combined with curettage appears to be superior to MTX plus curettage for treatment of CSP with high serum β-hCG level, though prospective trials are needed.

Rotas MA, Haberman S, Levgur M (2006) Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol 107:1373–1381CrossRefPubMed

Litwicka K, Greco E (2011) Caesarean scar pregnancy: a review of management options. Curr Opin Obstet Gynecol 23:415–421CrossRefPubMed

Zhang XB, Zhong YC, Chi JC et al (2012) Caesarean scar pregnancy: treatment with bilateral uterine artery chemoembolization combined with dilation and curettage. J Int Med Res 40:1919–1930CrossRefPubMed

Lian F, Wang Y, Chen W et al (2012) Uterine artery embolization combined with local methotrexate and systemic methotrexate for treatment of cesarean scar pregnancy with different ultrasonographic pattern. Cardiovasc Intervent Radiol 35:286–291CrossRefPubMed

Xia Wu, Xuebin Zhang, Jie Zhu et al (2012) Caesarean scar pregnancy: comparative efficacy and safety of treatment by uterine artery chemoembolization and systemic methotrexate injection. Eur J Obstet Gynecol Reprod Biol 161:75–79CrossRef

Yang XY, Yu H, Li KM et al (2010) Uterine artery embolisation combined with local methotrexate for treatment of caesarean scar pregnancy. Br J Obstet Gynaecol 117:990–996CrossRef

Cao S, Zhu L, Lin L et al (2014) Uterine artery embolization in cesarean scar pregnancy: safe and effective intervention. Chin Med J (Engl) 127(12):2322–2326

Özkan S, Çaliskan E, Özeren S et al (2007) Three-dimensional ultrasonographic diagnosis and hysteroscopic management of a vialle cesarean scar ectopic pregnancy. J Obstet Gynaecol 33:873–877

Litwicka K, Greco E (2013) Caesarean scar pregnancy: a review of management options. Curr Opin Obstet Gynecol 25(6):456–461CrossRefPubMed

10.

Hosni MM, Herath RP, Mumtaz R (2014) Diagnostic and therapeutic dilemmas of cervical ectopic pregnancy. Obstet Gynecol Surv 69:261–276CrossRefPubMed

11.

Van Mello NM, Mol F, Ankum WM et al (2012) Ectopic pregnancy: how the diagnostic and therapeutic management has changed. Fertil Steril 98:1066–1073CrossRefPubMed

12.

Guvenag Guven ES, Dilbaz S, Dilbaz B et al (2010) Comparison of single and multiple dose methotrexate therapy for unruptured tubal ectopic pregnancy: a prospective randomized study. Acta Obstet Gynecol Scand 89:889–895CrossRef

13.

Muraji M, Mabuchi S, Hisamoto K et al (2009) Cesarean scar pregnancies successfully treated with methotrexate. Acta Obstet Gynecol Scand 88:720–723CrossRefPubMed

14.

Bayoglu Tekin Y, Mete Ural U, Balık G et al (2014) Management of cesarean scar pregnancy with suction curettage: a report of four cases and review of the literature. Arch Gynecol Obstet 289:1171–1175CrossRefPubMed

15.

Wang H, Garmel S (2003) Successful term pregnancy after bilateral uterine artery embolization for postpartum hemorrhage. Obstet Gynecol 102:603–604PubMed

16.

Marcus S, Cheng E, Goff B (1999) Extrauterine pregnancy resulting from early uterine rupture. Obstet Gynecol 94:804–805PubMed

17.

Qian ZD, Huang LL, Zhu XM (2015) Curettage or operative hysteroscopy in the treatment of cesarean scar pregnancy. Arch Gynecol Obstet 292:1055–1061CrossRefPubMed

18.

Gao L, Huang Z, Gao J et al (2014) Uterine artery embolization followed by dilation and curettage within 24 hours compared with systemic methotrexate for cesarean scar pregnancy. Int J Gynaecol Obstet 127:147–151CrossRefPubMed

19.

Wang Y, Xu B, Dai S et al (2011) An efficient conservative treatment modality for cervical pregnancy: angiographic uterine artery embolization followed by immediate curettage. Am J Obstet Gynecol. doi:10.1016/j.ajog.2010.08.048 PubMedCentral

20.

Practice Committee of American Society for Reproductive Medicine (2013) Medical treatment of ectopic pregnancy: a committee opinion. Fertil Steril 100:638–644CrossRef

21.

Oron G, Tulandi T (2013) A pragmatic and evidence-based management of ectopic pregancy. J Minim Invasive Gynecol 20:446–454CrossRefPubMed

22.

Tomislav S, Josip M, Liana CS et al (2011) Uterine artery embolization as nonsurgical treatment of uterine myomas. ISRN Obstet Gynecol 2011:489281CrossRefPubMedPubMedCentral

23.

Zakaria MA, Abdallah ME, Shavell VI et al (2011) Conservative management of cervical ectopic pregnancy: utility of uterine artery embolization. Fertil Steril 95:872–876CrossRefPubMed

24.

Ben Naqi J, Helmy S, Ofili-Yebovi D et al (2007) Reproductive outcomes of women with a previous history of cesarean scar ectopic pregnancies. Hum Reprod 22:2012–2015CrossRef

25.

Maymon R, Svirsky R, Smorgick N et al (2011) Fertility performance and obstetric outcomes among women with previous cesarean scar pregnancy. J Ultrasound Med 30:1179–1184PubMed

26.

Yamaguchi M, Honda R, Uchino K et al (2014) Transvaginal methotrexate injection for the treatment of cesarean scar pregnancy: efficacy and subsequent fecundity. J Minim Invasive Gynecol. doi:10.1016/j.jmig.2014.03.024 PubMed

27.

Zhang B, Jiang ZB, Huang MS et al (2012) 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 23:1582–1588CrossRefPubMed

Title: Uterine artery embolization combined with curettage vs. methotrexate plus curettage for cesarean scar pregnancy
Authors: Wei Liu
Liang Shen
Qingwen Wang
Wei Wang
Zengtao Sun
Publication date: 01-07-2016
Publisher: Springer Berlin Heidelberg
Published in: Archives of Gynecology and Obstetrics / Issue 1/2016
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-015-3952-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Uterine artery embolization combined with curettage vs. methotrexate plus curettage for cesarean scar pregnancy

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2016

Epidural anesthesia for cesarean section for pregnant women with rheumatic heart disease and mitral stenosis

Ultrasound findings of a fetus with osteogenesis imperfecta type I

Diagnosis of aerobic vaginitis by quantitative real-time PCR

Early fetal growth in progesterone-treated IVF pregnancies

Relationship between melatonin receptor 1B (rs10830963 and rs1387153) with gestational diabetes mellitus: a case–control study and meta-analysis

Effectiveness and potential mechanisms of intralipid in treating unexplained recurrent spontaneous abortion