Uterine artery embolization followed by dilation and curettage within 24 hours compared with systemic methotrexate for cesarean scar pregnancy

Abstract

Objective: To assess the efficacy of uterine artery embolization (UAE) combined with dilation and curettage (D&C) within 24 hours for the treatment of a cesarean scar pregnancy (CSP), compared with methotrexate and D&C.

Methods: A retrospective cohort study of 119 women with CSP was conducted at two tertiary hospitals in Guangzhou and Shenzhen, China, during 2009-2012. Twenty-six women received systemic methotrexate followed by D&C, and 93 women were treated with UAE followed by D&C within 24 hours.

Results: Mean blood loss was 261.0±357.4 mL in the methotrexate group versus 14.1±40.6 mL in the UAE group (P<0.001). The time to resolution of the level of β-human chorionic gonadotropin was 40.5±17.2 days versus 15.4±7.7 days (P<0.001), respectively. The duration of hospitalization was 14.6±9.2 days versus 6.2±3.7 days (P<0.001), respectively. An additional intervention was needed in 9 (35%) women in the methotrexate group and in 5 (5%) in the UAE group (P<0.001).

Conclusion: UAE combined with D&C within 24 hours was an effective uterine preservation treatment for CSP, and was associated with less blood loss and a shorter hospital stay than administration of methotrexate followed by D&C.

Keywords: Cesarean scar pregnancy; Systemic methotrexate; Uterine artery embolization; Uterine curettage.