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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

Laparoscopic image of CSP showing the uterine segment with some large adhesions together with the surrounding tissues and caesarean scars from a patient with CSP. CSP, caesarean scar pregnancy.
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f5-etm-0-0-3489: Laparoscopic image of CSP showing the uterine segment with some large adhesions together with the surrounding tissues and caesarean scars from a patient with CSP. CSP, caesarean scar pregnancy.

Mentions: Of note, suction curettage may also be used to treat CSP, unlike ordinary curettage, because ultrasonography of CSP displays a thinned or absent myometrium between the gestational sac and bladder (<5 mm in two-thirds of cases). Thus, careful monitoring of curettage is necessary to avoid damaging the uterus. Compared with laparoscopy-guided and ultrasound-guided curettage, vaginal bleeding and length of stay in hospital showed no significant difference, although serum β-HCG levels decreased more rapidly with ultrasound-guided curettage than with laparoscopy-guided curettage. The rate of decline was 84.3±5.5 and 76.3±10.2%, respectively. The reason may be that the sonogram shows more clearly the location of the gestational sac and thickness of the myometrium between the gestational sac and bladder. When curettage is monitored by ultrasound, the operators can remove the ectopic sac under direct vision and have clear views of the endometrium and myometrium. The advantage of laparoscopy-guided curettage is observing the appearance of the uterus under direct vision during exploration. The topical purple bulge was usually seen in the lower segment over the caesarean scar. The blood vessels show hyperplasia in the same area (Fig. 4). However, in the current study, eight of the laparoscopy-guided cases showed the uterine segment had some heavy adhesions with the surrounding tissues and caesarean scars were not easy to expose (Fig. 5).


Curettage after uterine artery embolization combined with methotrexate treatment for caesarean scar pregnancy
Laparoscopic image of CSP showing the uterine segment with some large adhesions together with the surrounding tissues and caesarean scars from a patient with CSP. CSP, caesarean scar pregnancy.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f5-etm-0-0-3489: Laparoscopic image of CSP showing the uterine segment with some large adhesions together with the surrounding tissues and caesarean scars from a patient with CSP. CSP, caesarean scar pregnancy.
Mentions: Of note, suction curettage may also be used to treat CSP, unlike ordinary curettage, because ultrasonography of CSP displays a thinned or absent myometrium between the gestational sac and bladder (<5 mm in two-thirds of cases). Thus, careful monitoring of curettage is necessary to avoid damaging the uterus. Compared with laparoscopy-guided and ultrasound-guided curettage, vaginal bleeding and length of stay in hospital showed no significant difference, although serum β-HCG levels decreased more rapidly with ultrasound-guided curettage than with laparoscopy-guided curettage. The rate of decline was 84.3±5.5 and 76.3±10.2%, respectively. The reason may be that the sonogram shows more clearly the location of the gestational sac and thickness of the myometrium between the gestational sac and bladder. When curettage is monitored by ultrasound, the operators can remove the ectopic sac under direct vision and have clear views of the endometrium and myometrium. The advantage of laparoscopy-guided curettage is observing the appearance of the uterus under direct vision during exploration. The topical purple bulge was usually seen in the lower segment over the caesarean scar. The blood vessels show hyperplasia in the same area (Fig. 4). However, in the current study, eight of the laparoscopy-guided cases showed the uterine segment had some heavy adhesions with the surrounding tissues and caesarean scars were not easy to expose (Fig. 5).

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