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.