Guangwei Wang1, Xiaofei Liu, Dandan Wang, Qing Yang2. 1. Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110004, China. 2. Email: yangq@sj-hospital.org.
Abstract
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.
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.