[Clinical analysis on selective uterine artery embolization combined with hysteroscopic surgery for exogenous cesarean scar pregnancy in 67 cases].

OBJECTIVE

To investigate the safety and feasibility of uterine arterial embolization (UAE) combined with hystersocpic excisionl of exogenous cesarean scar pregnancy (CSP).

METHODS

Totally 67 patients with exogenous CSP treated with selective UAE combined with hysterscopic surgery in Shengjing Hospital of China Medical University were analyzed retrospectively; 35 patients in Group A (thickness of the cesarean scar > 3 mm), while 32 patients in Group B (thickness of the cesarean scar ≤ 3 mm). The following clinical parameters including operative time, intraoperative blood loss, quantity of postoperative uterine drainage, postoperative hospital days, the time for the mass absorption and the return of β-hCG to normal were compared.

RESULTS

All hysterscopic procedures were successfully completed in Group A, and only one case underwent a second hysteroscopic excision due to the 1-month postoperative ultrasound examination indicating a mass located in the cesarean scar and a slow decline of β-hCG. Three cases of Group B were transformed to laparoscopic or laparotomy operation and 7 cases underwent a second surgery. The volume of introperative blood loss was (97 ± 41) ml in Group A and (161 ± 92) ml in Group B, the difference was statistically significant (P < 0.01). But the operative time, quantity of postoperative uterine drainage, postoperative hospital days, the time for the retrun of β-hCG to normal and the mass absorption in Group A were (36 ± 9) minutes, (38 ± 13) ml, (3.5 ± 0.5) days, (26 ± 5) days, (82 ± 17) days, in Group B were (37 ± 9) minutes, (42 ± 16) ml, (4.0 ± 0.7) days, (28 ± 8) days, (88 ± 15) days, respectively, the differences were not statistically significant (all P > 0.05).

CONCLUSIONS

For exogenous CSP, when the thickness of cesarean scar is ≤ 3 mm, whether or not undertaking UAE, it should be seen as contraindication of hysterscopic surgery. UAE combined with hysterscopic surgery for the treatment of exogeous CSP with the cesarean scar thickness > 3 mm is safe and feasible according to patients condition and should be performed by experienced hysteroscopist.