Abstract
BackgroundThe aim of this study was to assess the feasibility, safety and outcome of the embolization of non-gonadal collateral supplying gestational sac (GS) in addition to uterine artery embolization (UAE), followed by hysteroscopic curettage for the management of cesarean scar pregnancy (CSP).MethodsA retrospective study was undertaken from January 2012 to September 2018 in 24 CSP patients in whom non-gonadal collaterals supplying GS were identified by arterial angiography performed immediately after UAE. These patients underwent attempt collateral embolization in addition to UAE, followed by hysteroscopic curettage for the management of CSP. The 24 patients were divided into two groups based on whether they underwent technically successful collateral embolization (UAE-SCE group) or failed collateral embolization (UAE-FCE group) in addition to UAE. The baseline characteristics and clinical outcomes including time for serum β-human chorionic gonadotropin (β-hCG) levels normalization, blood loss, secondary anemia, and pelvic pain were compared between the two groups. The paired t test and Man Whitney test were used for comparisons of discrete and numerical variables, respectively.ResultsCollateral embolization was techinically successful in 16 (66.7%, 16/24) patients and failed in the other 8 (33.3%, 8/24) patients. There were no significant differences between the two groups in baseline characteristics. The mean blood loss and secondary anemia in the UAE-SCE group were significantly less than UAE-FCE group. No significant difference was found between the two groups in the mean time for β-hCG levels normalization and pelvic pain.ConclusionsDuring the management of UAE combined with hysteroscopic curettage for CSP, additional embolization of non-gonadal collateral supplying GS during UAE is feasible and safe in patients with non-gonadal collateral supplying GS, and the additional embolization of the collateral may reduce blood bloss related to hysteroscopic curettage.
Highlights
The aim of this study was to assess the feasibility, safety and outcome of the embolization of nongonadal collateral supplying gestational sac (GS) in addition to uterine artery embolization (UAE), followed by hysteroscopic curettage for the management of cesarean scar pregnancy (CSP)
Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy defined as a gestational sac (GS) that implants at the site of a previous hysterotomy scar [1]
Technical and anatomic result In the 24 patients included for evaluation, collaterals supplying GS were unilateral in 21 patients and bilateral in 3 patients, resulting in a total of 27 collaterals
Summary
The aim of this study was to assess the feasibility, safety and outcome of the embolization of nongonadal collateral supplying gestational sac (GS) in addition to uterine artery embolization (UAE), followed by hysteroscopic curettage for the management of cesarean scar pregnancy (CSP). In the documented treatment options for the management of CSP, uterine artery embolization (UAE) combined with another techniques including hysteroscopic resection, dilation and curettage, or curettage has been described as an efficient and safe treatment modality. In these combined techniques, the main goal of UAE was to occlude blood flow of bilateral uterine arteries by which to reduce high risk of vaginal hemorrhage related to the following curettage or hysteroscopic resection and accelerate the resolution of the gestational sac [2,3,4]. It was documented that failure to recognize and/or embolize the collaterals supplying fibroid during UAE was responsible for substandard clinical result [5, 6]
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