Uterine artery embolisation combined with local methotrexate for treatment of caesarean scar pregnancy

Authors


Dr A Zheng, Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Sichuan, China. Email zhengai08@tom.com

Abstract

Please cite this paper as: Yang X-Y, Yu H, Li K-M, Chu Y-X, Zheng A. Uterine artery embolisation combined with local methotrexate for treatment of caesarean scar pregnancy. BJOG 2010;117:990–996.

Objective  The aim of the study was to determine the efficacy of uterine artery embolisation (UAE) combined with local methotrexate (MTX) for the treatment of caesarean scar pregnancy, compared with other traditional modalities, and to investigate the complications associated with this treatment.

Design  A retrospective cohort study.

Setting  A large obstetrics and gynaecology unit within a university hospital in China.

Sample  Women who were diagnosed with a caesarean scar pregnancy between January 2003 and December 2008, and who had informative case records, were included in the study.

Methods  We reviewed the results for all women who received one of three treatments: dilation and curettage (D&C) (11 patients; group A), systemic MTX (17 patients; group B), and UAE and local MTX (38 patients; group C).

Main outcome measures  The main outcome measures were success rate, blood loss, time for β human chorionic gonadotrophin (β-hCG) to decline to normal values, and the duration of hospital stay. Success was defined as a complete recovery with no severe complications and with the preservation of fertility.

Results  A total of 66 women diagnosed with caesarean scar pregnancy between January 2003 and December 2008 were identified, and their data were analysed. The success rate in group C was significantly higher than that in groups A and B after adjusting for β-hCG level (89.5 versus 27.3 and 58.8%, respectively; < 0.001). The mean blood loss in group C was lower than in the other two groups (240.5 versus 855.5 and 639.4 ml, respectively; = 0.008 and 0.009, respectively). The average time for β-hCG to decline to normal values was significantly shorter in group C than in group B (28.1 versus 44.3 days; = 0.021). A significantly shorter duration of hospital stay was observed in group C compared with group B (12.5 versus 22.0 days; = 0.024).

Conclusions  UAE combined with local MTX is of benefit to women wishing to preserve fertility, and is suitable for use as the primary treatment for caesarean scar pregnancy.

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