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Curettage after uterine artery embolization combined with methotrexate treatment for caesarean scar pregnancy

View Article: PubMed Central - PubMed

ABSTRACT

In the present study, we evaluated the diagnosis and management modalities of caesarean scar pregnancy (CSP). Thirty patients diagnosed with CSP were retrospectively studied between February, 2010 and February, 2012. Twenty-five patients were offered prophylactic uterine artery embolization (UAE) and methotrexate (MTX) prior to uterine suction curettage. Five cases were referred from other hospitals where the initial management with uterine suction curettage had resulted in uncontrollable massive haemorrhage, 4 of the cases had UAE and one proceeded immediately to hysterectomy. In the 25 patients treated with prophylactic UAE and MTX, 12 had laparoscopy-guided curettage and 13 had ultrasound-guided curettage without complication. The results showed that the 25 patients with CSP, who received prophylactic UAE and MTX prior to uterine curettage, recovered without complications. Five patients referred from other hospitals, where uterine curettage was the primary procedure, had severe complications including uncontrolled vaginal bleeding and uterine rupture. Four of the five patients were treated successfully with emergency UAE and the remaining patient underwent emergency hysterectomy as ultrasound examination detected significant haemorrhage between the uterus and the bladder. Of the 25 patients who received prophylactic UAE combined with MTX, there were no reports of irregular menstruation or serious adverse effects. Notably, the decrease in serum human chorionic gonadotropin (HCG) levels 3 days post-surgery was greater with ultrasound-guided curettage (84.3±5.5%) than with laparoscopy-guided curettage (76.3±10.2%). In summary, the data suggested that prophylactic UAE with MTX followed by ultrasound-guided curettage is the most effective therapeutic approach in CSP.

No MeSH data available.


Related in: MedlinePlus

Two examples of echo-images of CSP. Images were captured from a 30-year-old woman at 6 weeks of CSP with a history of one caesarean delivery. (A) TAS showing the midline of the uterus. (B) Transverse TVS showing the midline of the uterus. Arrow shows pregnant scar. CSP, caesarean scar pregnancy; TAS, transabdominal sonography; TVS, transvaginal sonography.
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f1-etm-0-0-3489: Two examples of echo-images of CSP. Images were captured from a 30-year-old woman at 6 weeks of CSP with a history of one caesarean delivery. (A) TAS showing the midline of the uterus. (B) Transverse TVS showing the midline of the uterus. Arrow shows pregnant scar. CSP, caesarean scar pregnancy; TAS, transabdominal sonography; TVS, transvaginal sonography.

Mentions: At Beijing Obstetrics and Gynaecology Hospital, transabdominal ultrasound with full bladder was performed initially to assess the pelvis and uterus with careful inspection of the interface between the anterior lower uterine segment and bladder. This was followed by a transvaginal ultrasound to allow for the fine-detail evaluation of the gestational sac in relation to the scar. The diagnosis of CSP in the first trimester was determined based on the following ultrasonographic criteria: i) an empty uterus with a clearly visualized endometrium; ii) an empty cervical canal; iii) an anteriorly located gestational sac with a decreased myometrium layer between the bladder and the sac; and iv) a reduced or absent myometrium between the gestational sac and bladder on a sagittal view of the uterus (this was observed to be <5 mm in two-thirds of cases) (11) (Fig. 1).


Curettage after uterine artery embolization combined with methotrexate treatment for caesarean scar pregnancy
Two examples of echo-images of CSP. Images were captured from a 30-year-old woman at 6 weeks of CSP with a history of one caesarean delivery. (A) TAS showing the midline of the uterus. (B) Transverse TVS showing the midline of the uterus. Arrow shows pregnant scar. CSP, caesarean scar pregnancy; TAS, transabdominal sonography; TVS, transvaginal sonography.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998184&req=5

f1-etm-0-0-3489: Two examples of echo-images of CSP. Images were captured from a 30-year-old woman at 6 weeks of CSP with a history of one caesarean delivery. (A) TAS showing the midline of the uterus. (B) Transverse TVS showing the midline of the uterus. Arrow shows pregnant scar. CSP, caesarean scar pregnancy; TAS, transabdominal sonography; TVS, transvaginal sonography.
Mentions: At Beijing Obstetrics and Gynaecology Hospital, transabdominal ultrasound with full bladder was performed initially to assess the pelvis and uterus with careful inspection of the interface between the anterior lower uterine segment and bladder. This was followed by a transvaginal ultrasound to allow for the fine-detail evaluation of the gestational sac in relation to the scar. The diagnosis of CSP in the first trimester was determined based on the following ultrasonographic criteria: i) an empty uterus with a clearly visualized endometrium; ii) an empty cervical canal; iii) an anteriorly located gestational sac with a decreased myometrium layer between the bladder and the sac; and iv) a reduced or absent myometrium between the gestational sac and bladder on a sagittal view of the uterus (this was observed to be <5 mm in two-thirds of cases) (11) (Fig. 1).

View Article: PubMed Central - PubMed

ABSTRACT

In the present study, we evaluated the diagnosis and management modalities of caesarean scar pregnancy (CSP). Thirty patients diagnosed with CSP were retrospectively studied between February, 2010 and February, 2012. Twenty-five patients were offered prophylactic uterine artery embolization (UAE) and methotrexate (MTX) prior to uterine suction curettage. Five cases were referred from other hospitals where the initial management with uterine suction curettage had resulted in uncontrollable massive haemorrhage, 4 of the cases had UAE and one proceeded immediately to hysterectomy. In the 25 patients treated with prophylactic UAE and MTX, 12 had laparoscopy-guided curettage and 13 had ultrasound-guided curettage without complication. The results showed that the 25 patients with CSP, who received prophylactic UAE and MTX prior to uterine curettage, recovered without complications. Five patients referred from other hospitals, where uterine curettage was the primary procedure, had severe complications including uncontrolled vaginal bleeding and uterine rupture. Four of the five patients were treated successfully with emergency UAE and the remaining patient underwent emergency hysterectomy as ultrasound examination detected significant haemorrhage between the uterus and the bladder. Of the 25 patients who received prophylactic UAE combined with MTX, there were no reports of irregular menstruation or serious adverse effects. Notably, the decrease in serum human chorionic gonadotropin (HCG) levels 3 days post-surgery was greater with ultrasound-guided curettage (84.3&plusmn;5.5%) than with laparoscopy-guided curettage (76.3&plusmn;10.2%). In summary, the data suggested that prophylactic UAE with MTX followed by ultrasound-guided curettage is the most effective therapeutic approach in CSP.

No MeSH data available.


Related in: MedlinePlus