Effect of Adjunctive Mifepristone Pre-treatment on Operative Efficiency and Postoperative Recovery in Cesarean Scar Pregnancy Undergoing Curettage After Uterine Artery Embolization.

AIM: This study aims to evaluate whether short-course mifepristone pre-treatment improves procedural efficiency and early recovery after uterine artery embolization (UAE), followed by dilation and curettage (D&C) for cesarean scar pregnancy.

METHODS: This retrospective study recruited 108 patients with cesarean scar pregnancy who underwent dilation and D&C between January 2020 and July 2023. Patients were divided into 2 groups according to the pre-treatment approach. The control group (n = 65) received pre-treatment with UAE alone, while the study group (n = 43) received pre-treatment with mifepristone in addition to the treatment used in the control group. The two groups were compared for operative metrics, early recovery, and postoperative adverse events. Serum β-human chorionic gonadotrophin (β-hCG) levels were evaluated upon admission and again on postoperative day 1. Patients were followed for one year to assess pregnancy-related outcomes, and the findings were compared between the two groups.

RESULTS: In the study group, the surgery duration was shorter, and the intraoperative blood loss was lower than in the control group (p < 0.05). The length of hospital stay was comparable between the two groups (p > 0.05). Similarly, the incidences of repeat D&C, massive hemorrhage, and re-embolization of the uterine artery were also comparable between groups (p > 0.05). There were no cases of conversion to laparotomy or hysterectomy in either group. At the time of admission, the β-hCG levels in the study group were not significantly different from those in the control group. However, on the first day after the procedure, the β-hCG levels in the study group were lower than those in the control group, but the difference did not reach statistical significance (p = 0.051). The study group had a shorter duration of vaginal bleeding and achieved normal menstrual function earlier than the control group (p < 0.05). The menstrual cycle was comparable between the two groups (p > 0.05). The incidences of fever, gastrointestinal symptoms, abnormal liver function, and intrauterine adhesions were also comparable between the two groups (p > 0.05). Follow-up analysis showed no significant differences between the two groups in subsequent pregnancy or recurrence of cesarean scar pregnancy (p > 0.05). Time to pregnancy was descriptively reported only among patients who achieved pregnancy and was not statistically compared because of the small number of events.

CONCLUSIONS: Incorporating short-course mifepristone pre-treatment to a standard uterine artery embolization-D&C strategy for cesarean scar pregnancy was associated with shorter operative time and better early recovery profiles, with satisfactory safety outcomes.