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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

Highly selective uterine artery angiograms. A 30-year-old woman with a history of one caesarean delivery having CSP at 6 weeks underwent preventive UAE. (A-G) Before UAE, selective uterine artery angiograms demonstrated enlarged and tortuous uterine arteries, with a hypervascular region overlying the lower uterine segment corresponding to the CSP region. (H and I) CSP image disappeared after an arterial occlusion was successfully achieved. CSP, caesarean scar pregnancy; UAE, uterine artery embolization.
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f2-etm-0-0-3489: Highly selective uterine artery angiograms. A 30-year-old woman with a history of one caesarean delivery having CSP at 6 weeks underwent preventive UAE. (A-G) Before UAE, selective uterine artery angiograms demonstrated enlarged and tortuous uterine arteries, with a hypervascular region overlying the lower uterine segment corresponding to the CSP region. (H and I) CSP image disappeared after an arterial occlusion was successfully achieved. CSP, caesarean scar pregnancy; UAE, uterine artery embolization.

Mentions: Twenty-five patients with a clear diagnosis of CSP were offered prophylactic UAE prior to uterine curettage. A right transfemoral approach was used for artery access, and each uterine artery was selectively catheterized with a 4- or 5-F Roberts uterine catheter. Prior to UAE, 50 mg of MTX was dissolved in 20 ml of physiologic saline solution. This dose was separated between the two uterine arteries and infused via the arterial catheter. UAE was performed by an experienced radiologist with the use of gelfoam particles (500–1,000 µm in diameter) mixed with nonionic contrast medium. Angiography was performed after UAE to confirm that the bilateral uterine arteries were occluded (Fig. 2). After 24–48 h, uterine curettage was performed under ultrasound-guided or laparoscopy-guided curettage to confirm the complete removal or destruction of the CSP mass. The other five patients, who were misdiagnosed from other hospitals as having an intrauterine pregnancy were treated with emergency UAE because of uncontrollable massive haemorrhage within 48 h after uterine curettage. Prophylactic anti-infection drugs were administered to prevent infection. Serum HCG levels were measured every three days.


Curettage after uterine artery embolization combined with methotrexate treatment for caesarean scar pregnancy
Highly selective uterine artery angiograms. A 30-year-old woman with a history of one caesarean delivery having CSP at 6 weeks underwent preventive UAE. (A-G) Before UAE, selective uterine artery angiograms demonstrated enlarged and tortuous uterine arteries, with a hypervascular region overlying the lower uterine segment corresponding to the CSP region. (H and I) CSP image disappeared after an arterial occlusion was successfully achieved. CSP, caesarean scar pregnancy; UAE, uterine artery embolization.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f2-etm-0-0-3489: Highly selective uterine artery angiograms. A 30-year-old woman with a history of one caesarean delivery having CSP at 6 weeks underwent preventive UAE. (A-G) Before UAE, selective uterine artery angiograms demonstrated enlarged and tortuous uterine arteries, with a hypervascular region overlying the lower uterine segment corresponding to the CSP region. (H and I) CSP image disappeared after an arterial occlusion was successfully achieved. CSP, caesarean scar pregnancy; UAE, uterine artery embolization.
Mentions: Twenty-five patients with a clear diagnosis of CSP were offered prophylactic UAE prior to uterine curettage. A right transfemoral approach was used for artery access, and each uterine artery was selectively catheterized with a 4- or 5-F Roberts uterine catheter. Prior to UAE, 50 mg of MTX was dissolved in 20 ml of physiologic saline solution. This dose was separated between the two uterine arteries and infused via the arterial catheter. UAE was performed by an experienced radiologist with the use of gelfoam particles (500–1,000 µm in diameter) mixed with nonionic contrast medium. Angiography was performed after UAE to confirm that the bilateral uterine arteries were occluded (Fig. 2). After 24–48 h, uterine curettage was performed under ultrasound-guided or laparoscopy-guided curettage to confirm the complete removal or destruction of the CSP mass. The other five patients, who were misdiagnosed from other hospitals as having an intrauterine pregnancy were treated with emergency UAE because of uncontrollable massive haemorrhage within 48 h after uterine curettage. Prophylactic anti-infection drugs were administered to prevent infection. Serum HCG levels were measured every three days.

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