Prophylactic uterine artery chemoembolization combined with sequential ultrasound-guided curettage of uterine cavity for the treatment of cesarean scar pregnancy:clinical observation of 231 patients

Objective: To evaluate the clinical application of prophylactic uterine artery chemoembolization (UACE) together with sequential ultrasound-guided curettage of uterine cavity for the treatment of cesarean scar pregnancy (CSP). Methods: The clinical data and follow-up results of 231 CSP patients who were treated with UACE together with sequential ultrasound-guided curettage of uterine cavity were retrospectively analyzed. Results: After UACE together with sequential ultrasound-guided curettage of uterine cavity, successful termination of pregnancy was achieved in all 231 patients, neither hemorrhagic shock nor death occurred. The median amount of blood loss during curettage of uterine cavity was 10 ml. After curettage of uterine cavity, the median values of RBC, HGB and HCT were 3.53 × 10¹²/L, 105 g/L and 32% respectively, the preoperative median values of which were 4.04 × 10¹²/L, 121 g/L and 36% respectively, indicating there were a slight reduction in RBC, HGB and HCT after UACE, the differences were statistically significant (P < 0.001). The median values of β-HCG measured before UACE and after curettage of uterine cavity were 29069.0 U/ml and 1723.5 U/ml respectively, the difference was statistically significant (P < 0.001). According to the gestational age, the patients were divided into group A (gestational age ≤ 56 days) and group B (gestational age 57-81 days). Further stratified analysis showed that no statistically significant differences in blood loss during curettage of uterine cavity and in reduction degree of RBC, HGB and HCT after UACE existed between group A and group B. Conclusion: Prophylactic UACE before CSP can effectively reduce the occurrence of massive bleeding during uterine curettage. For the treatment of CSP, UACE together with sequential ultrasound-guided curettage of uterine cavity is safe and reliable. Therefore, this therapy can be used as a routine treatment strategy for CSP. (authors)