Abstract
BackgroundUterine artery embolization (UAE) followed by suction and curettage is a common conservative treatment for caesarean scar pregnancy (CSP), but the advantages of suction and curettage alone are underestimated due to the lack of standards for selecting appropriate cases for which this approach would be applicable. We sought to identify indicators with which to assess the need for UAE during suction and curettage.MethodsThe prospective cohort consisted of 105 women diagnosed with CSP in Peking Union Medical College Hospital between January 2016 and September 2018 who were followed up until 60 days after surgery. The main outcome was the therapy used, and secondary outcomes included recovery, bleeding, surgery time, length of hospital stay, and total cost.ResultsWe found that β-human chorionic gonadotropin (β-hCG) levels were significantly lower (P < 0.05), foetal cardiac activity was significantly lower (P < 0.05), the myometrial layer was significantly thicker (P < 0.05), expenditures were lower and lengths of hospital stay were shorter in patients who received suction and curettage alone (the non-UAE group) than in those who received UAE followed by suction and curettage (the UAE+ group). In addition, for CSP patients, UAE might be less necessary when the myometrial thickness is ≥2 mm and the gestational sacmeasures ≤5 cm, and suction and curettage alone may be safer for these patients.ConclusionSuction and curettage alone is a more suitable option than UAE followed by suction and curettage because the former carries a lower cost, shorter length of hospital stay, and lower risk of adverse events. Regarding risk factors, patients with a lower uterine segment thickness ≥ 2 mm and a gestational mass diameter ≤ 5 cm have an increased probability of being successfully treated with suction and curettage alone.
Highlights
Uterine artery embolization (UAE) followed by suction and curettage is a common conservative treatment for caesarean scar pregnancy (CSP), but the advantages of suction and curettage alone are underestimated due to the lack of standards for selecting appropriate cases for which this approach would be applicable
Over the past few years, as our experience with treating CSP has grown, we have found that many patients can be successfully treated by suction and curettage alone
These criteria are coupled with transvaginal ultrasonography (TVUS) criteria, as described by Timor-Tritsch [15] et al, which include (1) an empty uterine cavity and cervical canal; (2) a gestational sac located anteriorly at the level equivalent to the prior lower uterine segment of the caesarean section scar; (3) evidence of functional trophoblastic/placental circulation on Doppler scans; and (4) a negative sliding organ sign, defined as the inability to displace the gestational sac from its position at the level of the internal os
Summary
Uterine artery embolization (UAE) followed by suction and curettage is a common conservative treatment for caesarean scar pregnancy (CSP), but the advantages of suction and curettage alone are underestimated due to the lack of standards for selecting appropriate cases for which this approach would be applicable. Caesarean scar pregnancy (CSP) occurs when a gestational sac is implanted within the scar of a previous caesarean section [1]. Half of the reported CSP cases were published within 2015, occurring primarily in China [5]. This situation may be attributable to the high and growing frequency of caesarean section (two to four million per year) and the increasing sensitivity of ultrasound, which has improved both the timeliness and the accuracy of diagnosis [6, 7]. Other countries with high rates of caesarean delivery are likely to encounter the same problem in the near future
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