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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

Dissection of uterus with CSP after hysterectomy. A 42-year-old woman with a history of one caesarean delivery had CSP for 8 weeks. She had uncontrolled haemorrhage due to CSP uterus rupture. (A) Whole uterus, (B) the gestational sac implanted into the caesarean scar myometrium, (C) chorionic villi from pregnancy at the caesarean scar, and (D) the sagittal angle of the cavity with respect to the scar tissue. CSP, caesarean scar pregnancy.
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f3-etm-0-0-3489: Dissection of uterus with CSP after hysterectomy. A 42-year-old woman with a history of one caesarean delivery had CSP for 8 weeks. She had uncontrolled haemorrhage due to CSP uterus rupture. (A) Whole uterus, (B) the gestational sac implanted into the caesarean scar myometrium, (C) chorionic villi from pregnancy at the caesarean scar, and (D) the sagittal angle of the cavity with respect to the scar tissue. CSP, caesarean scar pregnancy.

Mentions: A total of 30 women were included in the current study. Clinical presentation was described as follows: mild vaginal bleeding (11 patients); mild abdominal pain (1 patient); both of the above present (5 patients) and asymptomatic (8 patients; Table II). Twenty-five patients diagnosed for CSP by abdominal and TVS were approached to participate in the study. The patients received prophylactic UAE combined with MTX followed by uterine curettage and all 25 patients recovered without complications. The remaining five patients, who were misdiagnosed as having an intrauterine pregnancy in another hospital, were treated with suction curettage initially complicated by uncontrolled vaginal bleeding. Four of the five patients were treated successfully with UAE in our hospital. Five days after UAE, the patients underwent ultrasound-guided repeat uterine curettage because of a slow decrease in serum β-HCG or continued vaginal bleeding. The last patient underwent laparotomy and hysterectomy after an expanding haematoma was demonstrated between the uterus and bladder by transabdominal ultrasound (Fig. 3).


Curettage after uterine artery embolization combined with methotrexate treatment for caesarean scar pregnancy
Dissection of uterus with CSP after hysterectomy. A 42-year-old woman with a history of one caesarean delivery had CSP for 8 weeks. She had uncontrolled haemorrhage due to CSP uterus rupture. (A) Whole uterus, (B) the gestational sac implanted into the caesarean scar myometrium, (C) chorionic villi from pregnancy at the caesarean scar, and (D) the sagittal angle of the cavity with respect to the scar tissue. CSP, caesarean scar pregnancy.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f3-etm-0-0-3489: Dissection of uterus with CSP after hysterectomy. A 42-year-old woman with a history of one caesarean delivery had CSP for 8 weeks. She had uncontrolled haemorrhage due to CSP uterus rupture. (A) Whole uterus, (B) the gestational sac implanted into the caesarean scar myometrium, (C) chorionic villi from pregnancy at the caesarean scar, and (D) the sagittal angle of the cavity with respect to the scar tissue. CSP, caesarean scar pregnancy.
Mentions: A total of 30 women were included in the current study. Clinical presentation was described as follows: mild vaginal bleeding (11 patients); mild abdominal pain (1 patient); both of the above present (5 patients) and asymptomatic (8 patients; Table II). Twenty-five patients diagnosed for CSP by abdominal and TVS were approached to participate in the study. The patients received prophylactic UAE combined with MTX followed by uterine curettage and all 25 patients recovered without complications. The remaining five patients, who were misdiagnosed as having an intrauterine pregnancy in another hospital, were treated with suction curettage initially complicated by uncontrolled vaginal bleeding. Four of the five patients were treated successfully with UAE in our hospital. Five days after UAE, the patients underwent ultrasound-guided repeat uterine curettage because of a slow decrease in serum β-HCG or continued vaginal bleeding. The last patient underwent laparotomy and hysterectomy after an expanding haematoma was demonstrated between the uterus and bladder by transabdominal ultrasound (Fig. 3).

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