High-intensity focused ultrasound combined with dilatation and curettage for Cesarean scar pregnancy.

We describe a new technique for the management of Cesarean scar pregnancy (CSP), high-intensity focused ultrasound (HIFU) combined with dilatation and curettage (D&C), in four patients managed at our university hospital. All four had elevated serum human chorionic gonadotropin (hCG) levels and large lesions with strong peripheral color Doppler signals, indicating possible risk of profuse bleeding, and all four women wished to preserve their fertility. HIFU was performed under local anesthesia. Success of the treatment in all four cases was indicated by complete primary evacuation of the CSP and return of serum hCG to normal levels (serum hCG < 20 mIU/mL). However, one patient in whom there was a large scar defect and placental implantation underwent laparotomy to remove the trophoblastic tissue and repair the defect, although the hCG level had already returned to normal levels. HIFU, by utilizing ultrasound energy to heat tissue at a focal point, is able to stop embryonic cardiac activity and leads to a rapid reduction in serum hCG levels. Subsequent D&C under hysteroscopic guidance enables complete removal of products of conception following the HIFU procedure.