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. 2015 May;94(18):e854.
doi: 10.1097/MD.0000000000000854.

High-intensity focused ultrasound combined with suction curettage for the treatment of cesarean scar pregnancy

Xiaogang Zhu  1 , Xinliang Deng, Yajun Wan, Songshu Xiao, Jiping Huang, Lian Zhang, Min Xue
Affiliations

High-intensity focused ultrasound combined with suction curettage for the treatment of cesarean scar pregnancy

Xiaogang Zhu et al. Medicine (Baltimore). 2015 May.

Abstract

The aim of this study was to retrospectively evaluate the safety and feasibility of high-intensity focused ultrasound (HIFU) treatment combined with suction curettage under hysteroscopic guidance for cesarean scar pregnancy (CSP).Fifty-three patients with definite CSP were treated with HIFU followed by suction curettage under hysteroscopic guidance. All the patients received 1 session of HIFU ablation under conscious sedation. Suction curettage under hysteroscopic guidance was performed at an average of 2.9 (range: 1-5) days after HIFU ablation. Blood flow of pregnancy tissue before and after HIFU, intraoperative blood loss in suction curettage and hysteroscopy procedure, time for β-human chorionic gonadotropin (β-hCG) to return to normal level, and time for normal menstruation recovery were recorded.Immediately after HIFU treatment, color Doppler ultrasound showed that the fetal cardiac activity disappeared and the blood flow in the pregnancy tissue significantly decreased. All the patients underwent suction curettage under hysteroscopic guidance after the treatment of HIFU, the median volume of blood loss in the procedure was 20 mL (range: 10-400 mL). The average time for menstruation recovery was 35.1 ± 8.1 (range: 19-60) days. The average time needed for serum β-hCG to return to normal levels was 27.5 ± 6.4 (range: 12-40) days. The average hospital stay was 7.8 ± 1.5 (range: 5-11) days.Based on our results, it appears that HIFU combined with suction curettage under hysteroscopic guidance is safe and effective in treating patients with CSP at gestational ages <8 weeks.

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Conflict of interest statement

The authors have no funding or conflicts of interest to disclose

Figures

FIGURE 1
FIGURE 1
A gestational sac implanted in the previous cesarean scar with empty uterus cavity and cervical canal, and no myometrium was visible between the bladder and the sac.
FIGURE 2
FIGURE 2
A gestational sac implanted in the previous cesarean scar (sagittal view of the magnetic resonance imaging).
FIGURE 3
FIGURE 3
The pregnancy tissue located in the previous cesarean scar, with empty uterus cavity.
FIGURE 4
FIGURE 4
All the pregnancy tissues were removed from the previous cesarean scar.
FIGURE 5
FIGURE 5
The blood flow of pregnancy tissue examined by transabdominal color Doppler scanning contrast medium revealed before high-intensity focused ultrasound ablation.
FIGURE 6
FIGURE 6
The blood flow of pregnancy tissue examined by transabdominal color Doppler scanning contrast medium after high-intensity focused ultrasound ablation.
See this image and copyright information in PMC

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