Clinical comparison of high-intensity focused ultrasound versus uterine artery embolization with laparoscopic excision in type III cesarean scar ectopic pregnancy management: a retrospective cohort study.

BACKGROUND

We aimed to compare the clinical effectiveness of high-intensity focused ultrasound imaging (HIFU) versus uterine artery embolization (UAE) with laparoscopic excision in type III cesarean scar ectopic pregnancy (CSEP) management and the risk factors associated with intra-operative hemorrhage in these patients.

METHODS

Patients with type III CSEP who underwent laparoscopic excision with HIFU or UAE pretreatment in the Gynecology Department of the Third Xiangya Hospital of Central South University from 2014 to 2024 were retrospectively recruited for this study. Among the 49 participants, 27 were treated with HIFU and 22 with UAE followed by laparoscopic excision. The significance of the association between clinical characteristics and intra-operative hemorrhage was examined by logistic regression analysis.

RESULTS

No significant differences were detected in the age of patients, parity, number of cesarean sections, time since the previous cesarean section, gestational age, pretreatment vaginal bleeding, the level of pretreatment serum beta human chorionic gonadotropin, fetal heartbeat in ultrasound imaging before surgery, surgical outcomes and follow-up results between the two groups. No symptoms of pretreatment vaginal bleeding (p = 0.026, Odds Ratio [OR] = 27.880, 95% Confidence Interval [CI] 2.172-961.700) and color Doppler flow imaging (CDFI) grade 3 (p = 0.033, OR = 13.440, 95%CI 1.693-296.700) were identified as risk factors for excessive bleeding in laparoscopic excision surgery.

CONCLUSIONS

Both HIFU and UAE with laparoscopic excision are safe and effective for the management of type III CSEP. No symptom of vaginal bleeding and CDFI grade 3 before operation are risk factors for excessive bleeding in laparoscopic excision surgery for type III CSEP treatment.