An application of uterine artery chemoembolization in treating cesarean scar pregnancy

Abstract

Objective: To discuss the feasibility and safety of uterine artery chemoembolization in treating cesarean scar pregnancy (CSP).

Methods: During the period between 1(st) of May 2009 and 17(th) of January 2014, uterine artery chemoembolization with methotrexate (MTX) and gelatin sponge was performed in 31 patients diagnosed with CSP in Xinqiao Hospital. Curettage of uterus was carried out within 24-48 hours after the procedure.

Results: The success rate of bilateral uterine artery chemoembolization was 100%. The mean blood loss during curettage procedure was only 8.32±4.76 (2-20) ml. The mean time for serum β-HCG normalization was 33.81±17.47 (15-82) days, and the mean time for gestational sacs elimination was 29.52±20.93 (4-90) days. The mean time of hospital stay was 5.10±1.08 (4-8) days.

Conclusions: No serious complications occurred. The uterine artery chemoembolization is an effective and safe treatment for CSP, which greatly reduces the necessity of hysterectomy.

Keywords: Cesarean scar pregnancy (CSP); curettage of uterus; methotrexate (MTX); uterine artery chemoembolization (UAE).

Figure 1

Transvaginal sonogram of a cesarean scar pregnancy at 6+3 weeks (germ, 5.3 mm) showing deep implantation of a gestational sac into the site of a previous cesarean scar without any fetal parts visible in the uterine cavity.

Figure 2

Digital subtraction angiograms before (A and B) and after (C and D) uterine artery embolization. Before chemoembolization, bilateral uterine artery is hypertrophied and tortuous. The gestational sac is surrounded by numerous uterine artery branches. After chemoembolization, bilateral uterine artery occlusion is successfully performed. The vascularity of the gestational sac is completely disappeared.