Generic placeholder image

Current Molecular Medicine


ISSN (Print): 1566-5240
ISSN (Online): 1875-5666

Research Article

Risk Factor for Residue After Uterine Artery Chemotherapy and Embolization in Combination with Dilatation and Curettage for Treating Caesarean Scar Pregnancy

Author(s): Feng Cheng, Dan Shan, Sijia Guo, Shuang Cheng, Hongwei Yang, Jialin Han and Tongxiu Hu*

Volume 19, Issue 7, 2019

Page: [525 - 531] Pages: 7

DOI: 10.2174/1566524019666190612135728

open access plus


Objective: We aimed to investigate the potential risk factors for residual lesions after uterine artery chemotherapy and embolization (UACE) in combination with dilatation and curettage (D&C) in patients with cesarean scar pregnancy (CSP).

Settings: Retrospective case-control study.

Method: Univariate analysis and logistic analysis were applied to analyze these data to assess the risk factor of residue after UACE in combination with D&C.

Results: Gestational age, human chorionic gonadotropin (HCG) level, and the gestation sac (GS) evagination to the bladder were the risk factors for the postoperative lesion. The most relevant was GS evagination to the bladder, followed by the preoperative HCG level and the gestational age. We defined the cut-off value of gestational age as 28 days with a sensitivity and specificity of 100 and 0, respectively.

Conclusion: In cases with GS evagination to bladder and HCG of >28,113.65 mIU/ml as well as a gestational age of >28 days, the possibility of residual lesions was high.

Keywords: Caesarean scar pregnancy, risk factors, dilatation and curettage, residue, uterine artery embolization.

Timor-Tritsch IE, Monteagudo A. Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy. A review. Am J Obstet Gynecol 2012; 207: 14-29.
Ko JK, Li RH, Cheung VY. Caesarean scar pregnancy: a 10-year experience. Aust N Z J Obstet Gynaecol 2015; 55: 64-9.
Sekiguchi A, Okuda N, Kawabata I, Nakai A, Takeshita T. Ultrasound detection of lacunae-like image of a cesarean scar pregnancy in the first trimester. J Nippon Med Sch 2013; 80: 70-3.
Zhuang Y, Huang L. Uterine artery embolization compared with methotrexate for the management of pregnancy implanted within a cesarean scar. Am J Obstet Gynecol 2009; 201 152.e151-153.
Seow KM, Wang PH, Huang LW, Hwang JL. Transvaginal sono-guided aspiration of gestational sac concurrent with a local methotrexate injection for the treatment of unruptured cesarean scar pregnancy. Arch Gynecol Obstet 2013; 288: 361-6.
An X, Ming X, Li K, Wang J. The analysis of efficacy and failure factors of uterine artery methotrexate infusion and embolization in treatment of cesarean scar pregnancy. Sci World J 2013; 2013: 213603.
Chetty M, Elson J. Treating non-tubal ectopic pregnancy. Best Pract Res Clin Obstet Gynaecol 2009; 23: 529-38.
Yin X, Su S, Dong B, Ban Y, Li C, Sun B. Angiographic uterine artery chemoembolization followed by vacuum aspiration: an efficient and safe treatment for managing complicated cesarean scar pregnancy. Arch Gynecol Obstet 2012; 285: 1313-8.
Seow KM, Huang LW, Lin YH, Lin MY, Tsai YL, Hwang JL. Cesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol 2004; 23: 247-53.
Birch Petersen K, Hoffmann E, Rifbjerg Larsen C, Svarre Nielsen H. Cesarean scar pregnancy: a systematic review of treatment studies. Fertil Steril 2016; 105: 958-67.
Shen L, Tan A, Zhu H, Guo C, Liu D, Huang W. Bilateral uterine artery chemoembolization with methotrexate for cesarean scar pregnancy. Am J Obstet Gynecol 2012; 207: 386.e381-.
Le A, Shan L, Xiao T, Zhuo R, Xiong H, Wang Z. Transvaginal surgical treatment of cesarean scar ectopic pregnancy. Arch Gynecol Obstet 2013; 287: 791-6.
Hong Y, Guo Q, Pu Y, Lu D, Hu M. Outcome of high-intensity focused ultrasound and uterine artery embolization in the treatment and management of cesarean scar pregnancy: A retrospective study. Medicine (Baltimore) 2017; 96: e7687.
Li C, Li C, Feng D, Jia C, Liu B, Zhan X. Transcatheter arterial chemoembolization versus systemic methotrexate for the management of cesarean scar pregnancy. Int J Gynaecol Obstet 2011; 113: 178-82.
Fylstra DL. Ectopic pregnancy within a cesarean scar:areview. Obstet Gynecol Surv 2002; 57(8): 537-43.
Du YJ, Zhang XH, Wang LQ. Risk Factors for Haemorrhage during Suction Curettage after Uterine Artery Embolization for Treating Caesarean Scar Pregnancy: A Case-Control Study. Gynecol Obstet Invest 2015; 80: 259-64.
Lan W, Hu D, Li Z, Wang L, Yang W, Hu S. Bilateral uterine artery chemoembolization combined with dilation and curettage for treatment of cesarean scar pregnancy: A method for preserving the uterus. J Obstet Gynaecol Res 2013; 39: 1153-8.
Litwicka K, Greco E. Caesarean scar pregnancy: a review of management options. Curr Opin Obstet Gynecol 2013; 25: 456-61.
Wang H, Garmel S. Successful term pregnancy after bilateral uterine artery embolization for postpartum hemorrhage. Obstet Gynecol 2003; 102: 603-4.
Marcus S, Cheng E, Goff B. Extrauterine pregnancy resulting from early uterine rupture. Obstet Gynecol 1999; 94: 804-5.
Cao S, Zhu L, Jin L, Gao J, Chen C. Uterine artery embolization in cesarean scar pregnancy: safe and effective intervention. Chin Med J (Engl) 2014; 127: 2322-6.
Qian ZD, Huang LL, Zhu XM. Curettage or operative hysteroscopy in the treatment of cesarean scar pregnancy. Arch Gynecol Obstet 2015; 292: 1055-61.
Gao L, Huang Z, Gao J, Mai H, Zhang Y, Wang X. Uterine artery embolization followed by dilation and curettage within 24 hours compared with systemic methotrexate for cesarean scar pregnancy. Int J Gynaecol Obstet 2014; 127: 147-51.
Wozniak S, Pyra K, Kludka-Sternik M, et al. Uterine artery embolization using gelatin sponge particles performed due to massive vaginal bleeding caused by ectopic pregnancy within a cesarean scar: a case study. Ginekol Pol 2013; 84: 966-9.
Ananthakrishnan G, Murray L, Ritchie M, et al. Randomized comparison of uterine artery embolization (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): subanalysis of 5-year MRI findings. Cardiovasc Intervent Radiol 2013; 36: 676-81.
He Y, Wu X, Zhu Q, et al. Combined laparoscopy and hysteroscopy vs. uterine curettage in the uterine artery embolization-based management of cesarean scar pregnancy: a retrospective cohort study. BMC Womens Health 2014; 14: 116.
Liang Z, Su J, Yang H. [Feasibility of treatment of cesarean scar pregnancy with dilatation and curettage under ultrasound guidance]. Zhonghua Yi Xue Za Zhi 2015; 95: 3045-9.

© 2024 Bentham Science Publishers | Privacy Policy