A Comparison of Transvaginal Removal and Repair of Uterine Defect for Type II Cesarean Scar Pregnancy and Uterine Artery Embolization Combined With Curettage.

Shanshan Cao,Peipei Zhang,Guijing Qiu,Xinyan Wang,Qing Wu

doi:10.3389/fmed.2021.654956

Abstract

Background: There is no consensus on a standardized therapy for type II cesarean scar pregnancy (CSP II). The objective of the present study was to evaluate the efficacy and safety and compare costs associated with transvaginal removal and repair (TRR) of uterine defect for CSP II to those of uterine artery embolization (UAE) and curettage.Methods: We conducted a retrospective study that included 87 patients diagnosed with CSP II and treated by performing UAE in combination with curettage and hysteroscopy (n = 53), or TRR (n = 34). Clinical data and outcomes were analyzed.Results: UAE and TRR groups exhibited similar success rates. The TRR group had significantly lower complication rates (30.19 vs. 8.82%, P < 0.05) and lower total costs (13,765.89 ± 2,029.12 vs. 9,063.82 ± 954.67, P < 0.05) than the UAE group. The anterior myometrium of the lower uterine segment was relatively thicker after performing TRR, and no patient suffered from recurrent CSP II. The proportion of patients in the TRR group who had full-term delivery without uterine rupture was 88.24% (30/34), while four patients failed to pregnancy.Conclusion: TRR is a safe and effective treatment method for patients with CSP II and presents a highly cost-effective outcome, especially for patients with future fertility desire.

Highlights

Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy characterized by implantation of the gestational sac (GS) in the anterior uterine wall of the cesarean scar between the GS and the bladder [1]
We have reviewed our knowledge of transvaginal removal and repair (TRR) and systematically evaluated its feasibility and clinical value in treating uterine defect associated with CSP II when compared to uterine artery embolization (UAE) and curettage
No statistically significant differences were observed in gestational age, time interval from last cesarean section, serum β-hCG levels, myometrium thickness, and the anterior lower uterine segment myometrium thickness before administration of treatment between the TRR and UAE groups

Summary

Introduction

Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy characterized by implantation of the gestational sac (GS) in the anterior uterine wall of the cesarean scar between the GS and the bladder [1]. Blocking blood flow to the GS through uterine artery embolization (UAE) results in death of the embryo and reduces bleeding during curettage, and cesarean scar defect lacks an effective repair strategy. We hypothesized that transvaginal removal and repair (TRR) of uterine defect could have a satisfactory therapeutic outcome in patients with CSP II who have future fertility desire. We have reviewed our knowledge of TRR and systematically evaluated its feasibility and clinical value in treating uterine defect associated with CSP II when compared to UAE and curettage. There is no consensus on a standardized therapy for type II cesarean scar pregnancy (CSP II). The objective of the present study was to evaluate the efficacy and safety and compare costs associated with transvaginal removal and repair (TRR) of uterine defect for CSP II to those of uterine artery embolization (UAE) and curettage

Objectives

Methods

Results

Conclusion