Clinical study of two reversible arterial blockade methods in the treatment of scar pregnancy under combined hysterolaparoscopy.

OBJECTIVE

To assess and compare the clinical efficacy of scar pregnancy debridement by a combination of reversible bilateral uterine and internal iliac artery blockade with hysterolaparoscopy, as a management strategy for cesarean scar pregnancy.

METHODS

This retrospective study included patients diagnosed with cesarean scar pregnancy who underwent combined surgical intervention involving hysteroscopy and laparoscopy between May 2020 and February 2024. The study population was divided into two groups based on the type of arterial blockade used: a uterine artery blockade group and an internal iliac artery blockade group. Data were retrospectively collected from patient medical records, including baseline characteristics, surgery-related details, and postoperative outcome.

RESULT: The initial data revealed no discernible differences between the two groups in terms of age, number of caesarean sections, menstrual period, menstrual flow (light/medium/heavy), presence of dysmenorrhea, days of menopause, maximum human chorionic gonadotropin (hCG) levels, gestational tissue size on ultrasound imaging, reproductive hormones levels (E2/FSH/LH/progesterone), or anti-Müllerian hormone (AMH) (all P > 0.05). There were no apparent associations between the two groups in terms of the occurrence of adverse pregnancy outcome or ultrasound findings. However, the uterine artery group demonstrated shorter operative time, less bleeding, fewer postoperative hospital days, and lower overall hospital costs compared to the internal iliac artery group. Furthermore, the uterine artery group exhibited greater improvements in hCG and progesterone levels, menstrual periods, menstrual flow and dysmenorrhea than the internal iliac artery group. Additionally, the quality-of-life scores and a cumulative pregnancy rate were both significantly higher than in the control group.

CONCLUSION

The uterine artery group exhibited superior efficacy in the removal of scar pregnancies compared to the internal iliac artery group, under reversible uterine artery blockade by uterolaparoscopy in conjunction with bilateral uterine artery ligation. This procedure should be considered the preferred surgical approach for the aforementioned indication.