Uterine Artery Chemoembolization Research Articles

Retracted: Clinical Curative Effects and Influencing Factors of Uterine Artery Chemoembolization Combined with Uterine Curettage Treating with Cesarean Scar Pregnancy Patients.

[This retracts the article DOI: 10.1155/2022/7785573.].

Clinical Curative Effects and Influencing Factors of Uterine Artery Chemoembolization Combined with Uterine Curettage Treating with Cesarean Scar Pregnancy Patients.

Objective To explore the clinical curative effects of uterine arterial chemoembolization (UACE) combined with uterine curettage treating with cesarean scar pregnancy (CSP) patients, and analyze the influencing factors of postoperative efficacy. Methods A total of 86 patients with CSP from January 2019 to December 2021 in the Gynecology ward of our hospital were selected and divided into the control group (n = 43) and the observation group (n = 43) according to the random number method. The control group was treated with an injection of methotrexate (MTX) combined with uterine curettage, and the observation group was treated with UACE combined with uterine curettage. Two months after the operation, the therapeutic effect, cesarean scar mass, and β-human chorionic gonadotropin (β-HCG) level were observed and compared between the two groups. The general conditions of patients in two groups were recorded, and the influencing factors of surgical efficacy in patients were analyzed using univariate analysis and a multivariate logistic regression model. Results After treatment, the total effective rate of the observation group was significantly higher than that of the control group (P < 0.05). The volume of intraoperative blood loss, hospitalization period, menstrual recovery time, mass disappearance time, and β-HCG recovery time of the observation group were lower than those of the control group (P < 0.05). Single factor analysis showed that the number of cesarean sections, gestational age, the largest diameter of the gestational sac, the thinnest muscular layer, and the type of CSP can all affect postoperative efficacy (P < 0.05). Multivariate logistic analysis showed that the gestational age, a maximum diameter of a gestational sac, the thinnest muscular layer, and the type of CSP were independent factors influencing the postoperative efficacy of the patients (P < 0.05). Conclusion UACE combined with uterine curettage for CSP can significantly improve the curative effect, reduce intraoperative bleeding, and improve the recovery time of postoperative-related symptoms. The gestational age of the patient, the maximum diameter of the gestational sac, the thinnest muscular layer, and the type of CSP can independently affect the therapeutic effect of CSP patients. Fully understanding the high-risk factors that affect the efficacy of treatment of CSP, timely preventive measures, and targeted care can effectively improve the prognosis and reduce the risk of CSP.

Uterine artery chemoembolization for management of unruptured interstitial pregnancy diagnosed in the early first trimester

Background: With the increased frequency of diagnosis of interstitial pregnancy in the early first trimester, non-surgical management of unruptured interstitial pregnancy has become an important issue. However, management of unruptured interstitial pregnancy by uterine artery chemoembolization (UACE) with dactinomycin has never been evaluated via a case series. Methods: With this aim, a retrospective review of electronic chart records over a five-year period was performed, and a series of cases of unruptured interstitial pregnancy during the first trimester was extracted. Diagnostic procedures included ultrasonography, magnetic resonance imaging (MRI), and laparoscopic examination, if necessary. Conservative treatment regimen included UACE. Additional administration of methotrexate (MTX) was considered when an insufficient decline of serum β-hCG was noted. Clinical characteristics and treatment outcomes are described. Results: Among four women diagnosed with unruptured interstitial pregnancy at six weeks of gestation, one case was managed by laparoscopic cornuostomy due to concerns of rupture after the identification of thinning of the myometrium, whereas the other three cases were initially managed by UACE. One case of proximal interstitial pregnancy was diagnosed solely by MRI, whereas two cases of distal interstitial pregnancy was diagnosed by exploratory laparoscopy. Two cases were successfully managed by UACE alone, whereas one case required additional systemic administration of MTX to achieve resolution of gestational products after UACE. Thereafter, one patient conceived spontaneously and experienced a successful vaginal birth. Conclusions: This small case series emphasizes that UACE is a feasible minimally invasive option for the management of unruptured interstitial pregnancy identified in the early first trimester.

High-intensity focused ultrasound compared with uterine artery chemoembolization with methotrexate for the management of cesarean scar pregnancy.

To compare the effectiveness and safety of high-intensity focused ultrasound (HIFU) versus uterine artery chemoembolization with methotrexate for the management of cesarean scar pregnancy (CSP). A total of 170 women with CSP were enrolled in the retrospective cohort study from April 2016 to September 2020. One hundred women received HIFU followed by suction curettage, and 70 women were treated with uterine artery chemoembolization followed by suction curettage. The median blood loss during suction curettage was 20ml (range 2-800ml) in the HIFU group versus 20ml (range 5-200ml) in the chemoembolization group (P=0.837). The mean time for β-human chorionic gonadotropin normalization was 28.52±10.82days versus 26.69±8.97days (P=0.246), respectively. The mean time of menstruation recovery was 34.36±10.63days versus 31.93±8.53days (P=0.114), respectively. The incidence of adverse effects in the HIFU group was lower than that in the chemoembolization group (P=0.028). The median hospitalization time in the HIFU group was longer than that in the chemoembolization group (P=0.000). HIFU was as effective and safe as uterine artery chemoembolization in the management of CSP, and the incidence of adverse effects was lower.

Effect of Uterine Arterial Chemoembolization Combined with Ultrasound-Guided Uterine Curettage on Cervical Pregnancy and Influencing Factors.

This is a retrospective study to analyze the efficacy of uterine artery chemoembolization (UACE) combined with ultrasound-guided curettage in the treatment of cervical pregnancy and the factors affecting the postoperative outcome. A total of 26 subjects were included in the study and were divided into a control group of 12 and an observer group of 14, all patients with cervical pregnancy diagnosed in our hospital from January 2016 to January 2020. Patients in the control group were treated with methotrexate injection (MTX) combined with ultrasound-guided curettage in our hospital, while the observer group was treated with UACE combined with ultrasound-guided curettage. The efficacy of the two groups was evaluated at 3 months postoperatively, and data on patients' age, days of menopause, pregnancy frequency, and vaginal bleeding were collected retrospectively. Intraoperative bleeding, time to recovery of serum human chorionic gonadotropin (HCG), hospitalization time, time to return to normal menstruation, time to disappearance of gestational sac, pregnancy frequency, presence of endometrial inflammation, gestational week, maximum diameter of gestational sac, thinnest myometrium, endogenous-exogenous type, gestational sac size, and HCG level were recorded in both groups. Single-factor analysis and multifactor logistic regression models were used to analyze the factors influencing the surgical outcomes of patients. The results of the study showed that the overall efficiency of the observer group was significantly higher than that of the control group, while intraoperative bleeding, hospital stay, time to return to normal menstruation, and time to disappearance of the gestational sac were all lower than those of the control group (p < 0.05). The results of univariate and multifactorial analyses showed that endometrial inflammation, gestational week, maximum diameter of the gestational sac, thinnest myometrium, and endogenous-exogenous type could affect the patients' postoperative recovery (p < 0.05); gestational week, maximum diameter of the gestational sac, and thinnest myometrium were independent factors affecting the patients' postoperative recovery (p < 0.05). The above results suggest that UACE combined with ultrasound-guided uterine clearance for cervical pregnancy can significantly improve treatment efficacy, reduce intraoperative bleeding, and improve recovery time from postoperative related symptoms. The treatment efficacy of patients with cervical pregnancy was related to the gestational week, the maximum diameter of the gestational sac, and the thinnest muscle layer.

Recurrent cesarean scar pregnancy treated successfully with uterine artery chemoembolization.

Recurrent cesarean scar pregnancy treated successfully with uterine artery chemoembolization.

Robotic CSP Resection and Hysterotomy Repair

To demonstrate a technique for the robot-assisted laparoscopic surgical management of cesarean section scar ectopic pregnancy (CSP) and hysterotomy repair. Step-by-step presentation of the procedure using video. CSP is a rare form of ectopic pregnancy. The incidence of CSP has been increasing with rising cesarean deliveries and is estimated to range from 1 of 1800 to 1 of 2500 of all pregnancies. Various management of CSP have been used such as systemic or local methotrexate, surgical resection, and uterine artery chemoembolization. Exogenic or deep CSP occurs when the gestational sac is deeply embedded in the scar and the surrounding myometrium and grows toward the bladder. Surgical resection of this type of CSP seemed reasonable, which could shorten hospitalization and follow-up time and reduce the failure rate of treatment. For its magnification of the 3-dimensional laparoscope, flexibility endo-wrist, and stabilization of instruments within the surgical field, robot-assisted laparoscopic resection can be performed to manage this type of complex procedure. In this video, we describe our technique for robot-assisted laparoscopic management of a CSP and a hysterotomy repair. We present the case of a 34-year-old gravida 2 para 1 woman with the finding of a 7-week pregnancy embedded in the cesarean section scar. The patient had undergone 1 previous uncomplicated cesarean section at term. On presentation, her β-human chorionic gonadotropin level was 9212 IU/L. In this case, the gestational sac was deeply embedded in the scar and the surrounding myometrium and was growing toward the bladder. A decision was made to proceed with surgical treatment in the form of a robot-assisted laparoscopic resection of the ectopic pregnancy and the hysterotomy repair. The surgery was uneventful, and the patient was discharged home within 48 hours of her procedure. No residual scar defect was visible on follow-up ultrasonography 1 month after surgery. Forty days after surgery, the patient had resumed normal menstruation and was followed up for 3 years with regular menstruation and no abnormal uterine bleeding. Robot-assisted laparoscopic excision of CSP and hysterotomy repair is an effective procedure for the management of this increasingly more common condition. The use of a cervix dilator and robot-assisted laparoscopic suturing can prevent hemorrhage and peripheral tissue damage and allow for the safe removal of the ectopic pregnancy with multilayer repair of the uterine defect.

Retrospective study of patients with cesarean scar pregnancies treated by uterine artery chemoembolization and curettage.

To evaluate the efficacy and long-term prognosis of uterine artery chemoembolization (UACE) combined with curettage for treatment of cesarean scar pregnancy (CSP). Data were retrospectively reviewed from women with CSPs treated by UACE with curettage at Women's Hospital of Zhejiang University, Hangzhou, a tertiary obstetrics and gynecologic center in China, between December 2006 and December 2016. Information on clinical characteristics and treatment outcomes was obtained from medical records and follow-up interviews. There were 383 patients included; 379 (99.0%) women were successfully treated. Risk factors associated with intraoperative bleeding were size of gestational mass (P=0.001), presence of fetal heart beat (P=0.002), and type of CSP (P=0.002). Among 301 women with complete medical records over a mean±SD follow-up of 49.8±30.2months, 164 (54.5%) women resumed normal menstruation and only 22 (7.3%) experienced a reduction in menstrual volume of more than one-half. Among 89 women attempting to conceive, the conception rate was 69% (61/89), the positive pregnancy rate was 80% (49/61), and 35 live neonates were delivered. UACE combined with curettage was found to be an effective fertility-sparing treatment for CSP. Further, the approach did not seem to harm future reproductive ability.

Comparison of Five Treatment Strategies for Cesarean Scar Pregnancy

Objective: To explore appropriate treatment strategy for cesarean scar pregnancy (CSP) in the first and second trimester. Methods: Clinical characteristics and treatment strategies in 182 patients with CSP were retrospectively analyzed. Treatment strategies were as follows: Group A (n = 102), uterine artery chemoembolization (UACE) followed by dilation and curettage (DC Group B (n = 63), DC Group C (n = 6), hysteroscopy; Group D (n = 6), laparotomy; and Group E (n = 5), laparoscopy. The basic clinical findings were collected and analyzed, along with the curative effects. Results: The preoperative serum beta-human chorionic gonadotropin (β-HCG) level was in the order of Group D, A>B, C>E (P = 0.001); the size of gestational sac (GS) was in the order of Group D, E>A, C>B (P = 0.000); and the thickness of the anterior myometrium was in the order of Group B>A, C>D, E (P = 0.000). Three cases in the second trimester were all in Group D; two cases were treated with UACE before laparotomy with moderate blood loss (100 and 200 mL, respectively) and the third case was initially treated with D&C and had severe hemorrhage. Conclusions: The diameter of GS, thickness of the anterior myometrium, and preoperative β-HCG level are important factors for the choice of treatment. UACE combined with D&C is a useful measure for most Type 2 CSP cases in the first trimester. For Type 2 CSP cases in the second trimester, UACE before laparotomy could be a reasonable choice.

Characteristics of women with mixed mass formation after evacuation following uterine artery chemoembolization for cesarean scar pregnancy.

To explore the efficacy of treatment for early cesarean scar pregnancy (CSP) and to evaluate the characteristics of women with subsequent mixed mass formation. Women with CSP, who received UACE followed by evacuation, were retrospectively analyzed. Clinical/sonographic characteristics in patients with or without mixed mass formation were compared. From a total of 395 cases, 105 cases had a pregnancy residual with mixed mass formation. Blood loss and subsequent salvage intervention were significantly lower in patients without mixed mass, although all women retained their uteri. It required 50days for the mass to resolve, 40days for β-hCG concentrations to drop back to normal, and 61days for menses to be restored; all of which were significantly longer than the same indices in women without a mixed mass. Clinical/sonographic characteristics predicting residual mass formation were maximal diameter of gestational sac (OR=1.05, P=0.001, with a sensitivity and specificity of 68.6 and 80.3%, respectively), presence of a fetal heart beat (OR=2.63, P=0.002, with a sensitivity and specificity of 62.9 and 67.2%, respectively), remnant myometrial thickness (OR=108.91, P=0.001 when thickness was less than 1mm, with a sensitivity and specificity of 42.9% and 96.6%), location of gestational sac (OR=59.20, P=0.01 for complete type, with a sensitivity and specificity of 99.0 and 36.9%), and Doppler signal grading (OR=8.08, P=0.013 for Grade III, with a sensitivity and specificity of 83.8 and 51.0%). UACE followed by evacuation was effective for CSP and subsequent mixed mass formation could be predicted by some clinical/sonographic characteristics.

Clinical features and outcome of cesarean scar pregnancy

Objective: To analysis the clinical features of cesarean scar pregnancy (CSP), to evaluate the therapeutic effect of various treatments, especially the feasibility and advantage of Methotrexate (MTX)-Uterine artery embolization (UAE)- Sonogrphy directed-In situs aspiration sequential therapy based on the pregnancy sac three-dimensional conformation analysis (3D-MESIA). Methods: From January 2007 to December 2014, 99 subjects who were diagnosed as CSP in Chaoyang Hospital of Capital Medical University were studied retrospectively. According to different treatment, they were divided into six groups: 51 cases treated by 3D-MESIA (group A), 8 cases treated by systemic MTX injection (group B), 9 cases treated by uterine artery chemoembolization or uterine artery embolization combined with systemic MTX injection (group C), 10 cases treated by uterine curettage after systemic MTX injection (group D), 11 cases treated by uterine curettage after uterine artery embolization (group E), 10 cases treated by uterine curettage directly (group F). Each group according to the CSP classification can be divided into two subgroups: endogenous CSP and exogenous CSP. The intraoperative blood loss, operative time, β-hCG clearance time, lesion absorption time, hospitalization time, hospitalization expenses, the success rate were compared among the six groups and two subgroups. Results: (1) The operative time and blood loss of endogenous CSP had no significant difference in different operative methods (P>0.05). β-hCG clearance time and lesion absorption time of endogenous CSP in group B were significantly longer than the other five groups (P<0.05). (2) The intraoperative blood loss in group A and group E compared with group D and group F was decreased significantly (P<0.05). β-hCG clearance time and lesion absorption time of exogenous CSP in group A were significantly shorter than those in the other five groups (P<0.05). (3) The hospitalization time in group E and group F were obviously shorter than that in other groups (P<0.05). The hospitalization expense in group B and group F were obviously less than that in other groups (P<0.05). (4) The success rate of endogenous CSP in group F was the lowest, but the difference had no significant statistical significance (P>0.05). The success rate of exogenous CSP in group A and group E were obviously higher than that of the other four groups (P<0.05). Conclusion: The treatment effect of MTX therapy alone or uterine artery embolization for CSP is poor. 3D-MESIA is safe and effective for endogenous CSP. It is easy to promote and can be used as the initial treatment of exogenous CSP. If it fails, the laparoscopic removal of lesions and scar repair could be the remedial measure.

Randomized controlled trial of hysteroscopy or ultrasonography versus no guidance during D&C after uterine artery chemoembolization for cesarean scar pregnancy

ObjectiveTo compare the complication rates after uterine artery chemoembolization (UACE) followed by dilation and curettage (D&C) guided by different types of monitoring for treatment of cesarean scar pregnancy (CSP). MethodsA randomized controlled trial was undertaken of women with CSP attending a hospital in Wuhan, China, between June 1, 2010, and June 30, 2014. Using sealed opaque envelopes containing random numbers, participants were randomly allocated to undergo D&C with hysteroscopy monitoring, ultrasonography monitoring, or no monitoring. Participants and investigators were masked to group assignment. The primary outcome was the number of participants with complications at 2 months of follow-up after D&C. Analyses were by intention to treat. ResultsAmong 144 participants, 48 were assigned to hysteroscopy monitoring, 44 to ultrasonography monitoring, and 52 to no monitoring. Complications were noted for 1 (2.1%) patient in the hysteroscopy group, 2 (4.5%) in the ultrasonography group, and 12 (23.1%) in the no monitoring group (P=0.001). ConclusionHysteroscopy or ultrasonography monitoring of D&C after UACE for CSP treatment can decrease the complication rate.ClinicalTrials.gov: NCT02357095.

Первый опыт применения селективной химиоэмболизации маточных артерий у пациенток с раком шейки матки

Introduction. Women with locally advanced cervical cancer often treated with palliative uterine artery chemoembolization. Material and methods. Ten women with locally advanced cervical cancer has been investigated. The Group 1 has been consisted of 6 (60%) patients with primary uterine artery chemoembolization. In the Group 2 were 4 (40%) women in whom the endovascular procedure was performed after courses of chemoradiotherapy. Tumor size changes were evaluated using the magnetic resonance imaging. Results. After 3 months in the Group 1 patients a significant regression of the tumor size was observed. In the Group 2 there were no a significant regression of the tumor size. Выводы. Palliative uterine artery chemoembolization may be used in patients with locally advanced cervical cancer. Primary uterine artery chemoembolization is more effective, than endovascular procedure after courses of chemoradiotherapy.

Uterine artery embolization combined with intra-arterial MTX infusion: its application in treatment of cervical pregnancy.

To investigate the efficacy and safety of uterine artery chemoembolization (UAE) combined with intra-arterial MTX infusion for the treatment of cervical pregnancy. Retrospective chart review for 26 cervical pregnancy patients treated at Renji hospital between January 2000 and December 2012. 14 patients received UAE combined with intra-arterial MTX infusion (UAE group) and 12 patients received single intramuscular MTX injection combined with subsequent uterine curettage (non-UAE group). All 14 patients in the UAE group were treated successfully and 1 patient in the non-UAE group had 1200 ml vaginal bleeding during uterine curettage and was then treated with emergency UAE. The mean estimated blood loss during uterine curettage in the UAE group was much less than in non-UAE Group. A quicker regression of serum β-hCG level and normal menses resumed and a shorter hospital stay were observed in the UAE group than in the non-UAE group. Uterine artery chemoembolization combined with intra-arterial MTX infusion is an efficient conservative treatment for cervical pregnancy.

Bilateral Uterine Artery Chemoembolization with Methotrexate and Gelatine Foam for Caesarean Scar Pregnancy – Case Report

Bilateral Uterine Artery Chemoembolization with Methotrexate and Gelatine Foam for Caesarean Scar Pregnancy – Case Report

Superselective uterine artery chemoembolization for treatment of locally advanced cervical cancer

Objective To investigate the efficacy of uterine artery chemoembolization in the treatment of locally advanced cervical cancer. Methods A total of 268 patients with locally advanced cervical cancer were treated with uterine artery chemoembolization in our department.The stage distribution among the patients included 132 stageⅠB2,85 stageⅡA1 and 51 stageⅡA2.There were 223 patients of squamous cell carcinoma,24 patients of adenocarcinoma,9 patients of adenosquamous carcinoma,small cell carcinoma of the 7 patients,5 patients of neuroendocrine carcinoma.Transcatheter uterine artery infusion of paclitaxel and nedaplatin,gelatin sponge particles was applied for uterine artery embolization.The clinicopathological parameters were analyzed,and their impacts on tumor response were investigated.RECIST criteria were used to evaluate the response in solid tumors.Student t test was used to compare cervical tumor diameter before and after treatment,and Chi-square test was used for comparison of categorical data.Follow up examinations included pelvic ultrasound,gynecology,vaginal stump cell smears. Results Of the 268 patients,74 (27.6%) patients showed a complete response,160 (59.7%) patients had a partial response to uterine artery chemoembolization,and the overall response rate was 87.3%.A total of 258 (96.3%) patients underwent surgery,and pathological complete response were identified in 46 (17.2%).Forty (14.9%) patients were found to have lymph node metastasis after surgery.Response rates of stageⅠB2 andⅡA cases were 94.7% and 80.1%,respectively,P<0.05.Patients with squamous cell carcinoma showed a better response rate than patents with other pathological types (94.2% vs. 53.3%),P<0.05.Initial tumor volume and cycles of preoperative uterine artery chemoembolization had no effect on the response rate. Conclusions Uterine artery chemoembolization can increase the rate of surgical resection of patients with locally advanced cervical cancer and can improve the reaction rate with tolerable side effect.It is an applicable option of treatment for patients with locally advanced cervical cancer in the neoadjuvant treatment. Key words: Uterine cervical neoplasms; Chemotherapy; Embolism; Paclitaxel; Nedaplatin

Bilateral uterine artery chemoembolization combined with dilation and curettage for treatment of cesarean scar pregnancy: A method for preserving the uterus

The aim of this study was to respectively evaluate the feasibility and safety of bilateral uterine artery chemoembolization (UACE) combined with dilation and curettage (D&C) for the treatment of cesarean scar pregnancy (CSP). Our study was approved by our institutional review board, with informed patient consent. From January 2004 to December 2010, 79 patients with CSP underwent UACE in our institution, with transcatheter infusion of 30-50 mg methotrexate into the bilateral uterine artery before embolization with sponge particles. Within 24-48 h after UACE, D&C was performed on all the patients under the guidance of ultrasonography and hysteroscopy. All the 79 patients diagnosed as having CSP were included in our study and their data were analyzed. All the patients recovered completely without severe complications. The average hemorrhage volume during D&C was 30 mL, but none of them needed transfusion. The uteri of all the patients were preserved, and none of them had to undergo hysterectomy. The safety rate was 100%. The mean duration of hospital stay was 10.5 days. UACE performed prior to D&C is a feasible method and it may reduce hemorrhage complications and risk of hysterectomy in patients with CSP.

The efficacy of uterine artery chemoembolization for Cesarean scar pregnancy

Objective To explore the efficacy and safety of uterine artery chemoembolization in the treatment of Cesarean scar pregnancy.Methods 42 women with Cesarean scar pregnancy were randomly divided into group A or B.Group A received uterine artery chemoembolization 3 days before ultrasoundguided dilatation and curettage.Group B received methotrexate and mifepristone and then ultrasoundguided dilatation and curettage as β-HCG level declined to less than 200IU/L.Length of hospital stays,intraoperative blood loss,β-HCG,and menstrual recovery were observed in both groups.Results In group A,length of hospital stay was (11.2 ± 1.7)days,intraoperative blood loss was (35.2 ± 18.4)ml,time to reduction of β-HCG to normal level was (21.2 ± 3.5)days,and time to menstrual recovery was (30.0 ± 4.0)days; while in group B,length of hospital stay was (20.6 ± 5.6)days,intraoperative blood loss was (225.7 ± 125.6)ml,time to reduction of β-HCG to normal level was (36.0 ± 9.9)days,and time to menstrual recovery was (49.8 ± 7.7)days,with significant statistical differences (P＜0.05).Conclusions Uterine artery chemoembolization combined with ultrasound-guided dilatation and curettage can significantly shorten length of hospital stay and reduce intraoperative hemorrhage due to curettage,and is less invasive.Patients have rapid recovery and can preserve reproductive function..This therapy is the best approach for Cesarean scar pregnancy. Key words: Uterine artery chemoembolization; Cesarean scar pregnancy; Dilatation and curettage

Caesarean Scar Pregnancy: Treatment with Bilateral Uterine Artery Chemoembolization Combined with Dilation and Curettage

This study investigated bilateral uterine artery chemoembolization (BUACE) combined with dilation and curettage (D&C) in caesarean scar pregnancy (CSP). Nineteen women with CSP were referred for interventional radiology. In 13 patients, BUACE was performed before D&C, following a diagnosis of CSP. A further six patients received BUACE for massive vaginal bleeding after D&C for inevitable miscarriage; the diagnosis of CSP was subsequently confirmed ultrasonographically. BUACE of the uterine arteries was performed using gelfoam particles following intra-arterial infusion of 100 mg/m(2) methotrexate. BUACE was technically successful and immediate haemostasis was achieved in all patients. Blood loss was significantly greater during D&C undertaken before BUACE compared with D&C after BUACE, but this bleeding was controlled by BUACE. No patient required further surgical intervention and there were no severe complications. The gestational sac and placenta could no longer be detected ultrasonographically and the menstrual cycle returned to normal 2-3 months after treatment in all patients. BUACE followed by D&C seems to be a safe and effective treatment for CSP and should be considered as a treatment of choice.

Bilateral uterine artery chemoembolization with methotrexate for cesarean scar pregnancy

The objective of the study was to assess the efficacy of uterine arteries embolization (UAE) for the treatment of cesarean scar pregnancies (CSP). Forty-six women with CSP were identified between March 2008 and March 2010. All of the patients underwent UAE combined with local methotrexate. Forty-five patients were successfully treated. One patient had an emergency hysterectomy after 20 days because of massive vaginal hemorrhage. The mean time until normalization of serum β-human chorionic gonadotrophin was 37.7 days, and the mean time until CSP mass disappearance was 33.3 days. The mean hospitalization time was 10.5 days. The complications were mainly fever and pain, which were alleviated with symptomatic treatment. All 45 patients had recovered their normal menstruation at follow-up. Bilateral uterine artery chemoembolization with methotrexate appears to be a safe and effective treatment for CSP and causes less morbidity than current approaches.