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Erschienen in: Archives of Gynecology and Obstetrics 1/2016

18.11.2015 | Maternal-Fetal Medicine

Uterine artery embolization combined with curettage vs. methotrexate plus curettage for cesarean scar pregnancy

verfasst von: Wei Liu, Liang Shen, Qingwen Wang, Wei Wang, Zengtao Sun

Erschienen in: Archives of Gynecology and Obstetrics | Ausgabe 1/2016

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Abstract

Purpose

To compare the efficacy and safety of uterine artery embolization (UAE) combined with curettage and methotrexate (MTX) plus curettage in the treatment of cesarean scar pregnancy (CSP).

Methods

From January 2005 to December 2013, we treated 38 CSP patients with UAE combined with curettage, and another 26 patients with CSP were treated with methotrexate (MTX) plus curettage. The resulting data were analyzed statistically.

Results

The median volume of blood loss was 17.5 ml in the UAE combined with curettage (UAE-C) group vs. 335 ml in the MTX plus curettage (MTX-C) group (p < 0.001). The time from the procedure till β-human chorionic gonadotropin (β-hCG) concentration returned to normal was 25.13 ± 3.74 days in the UAE-C group vs. 56.15 ± 15.99 days in the MTX-C group (p < 0.001). The duration of hospitalization was 7.44 ± 1.92 vs. 19.38 ± 8.75 days, respectively (p < 0.001). The percentage of side effects in the UAE-C group was significantly lower than in the MTX-C group.

Conclusions

UAE combined with curettage appears to be superior to MTX plus curettage for treatment of CSP with high serum β-hCG level, though prospective trials are needed.
Literatur
1.
Zurück zum Zitat Rotas MA, Haberman S, Levgur M (2006) Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol 107:1373–1381CrossRefPubMed Rotas MA, Haberman S, Levgur M (2006) Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol 107:1373–1381CrossRefPubMed
2.
Zurück zum Zitat Litwicka K, Greco E (2011) Caesarean scar pregnancy: a review of management options. Curr Opin Obstet Gynecol 23:415–421CrossRefPubMed Litwicka K, Greco E (2011) Caesarean scar pregnancy: a review of management options. Curr Opin Obstet Gynecol 23:415–421CrossRefPubMed
3.
Zurück zum Zitat Zhang XB, Zhong YC, Chi JC et al (2012) Caesarean scar pregnancy: treatment with bilateral uterine artery chemoembolization combined with dilation and curettage. J Int Med Res 40:1919–1930CrossRefPubMed Zhang XB, Zhong YC, Chi JC et al (2012) Caesarean scar pregnancy: treatment with bilateral uterine artery chemoembolization combined with dilation and curettage. J Int Med Res 40:1919–1930CrossRefPubMed
4.
Zurück zum Zitat Lian F, Wang Y, Chen W et al (2012) Uterine artery embolization combined with local methotrexate and systemic methotrexate for treatment of cesarean scar pregnancy with different ultrasonographic pattern. Cardiovasc Intervent Radiol 35:286–291CrossRefPubMed Lian F, Wang Y, Chen W et al (2012) Uterine artery embolization combined with local methotrexate and systemic methotrexate for treatment of cesarean scar pregnancy with different ultrasonographic pattern. Cardiovasc Intervent Radiol 35:286–291CrossRefPubMed
5.
Zurück zum Zitat Xia Wu, Xuebin Zhang, Jie Zhu et al (2012) Caesarean scar pregnancy: comparative efficacy and safety of treatment by uterine artery chemoembolization and systemic methotrexate injection. Eur J Obstet Gynecol Reprod Biol 161:75–79CrossRef Xia Wu, Xuebin Zhang, Jie Zhu et al (2012) Caesarean scar pregnancy: comparative efficacy and safety of treatment by uterine artery chemoembolization and systemic methotrexate injection. Eur J Obstet Gynecol Reprod Biol 161:75–79CrossRef
6.
Zurück zum Zitat Yang XY, Yu H, Li KM et al (2010) Uterine artery embolisation combined with local methotrexate for treatment of caesarean scar pregnancy. Br J Obstet Gynaecol 117:990–996CrossRef Yang XY, Yu H, Li KM et al (2010) Uterine artery embolisation combined with local methotrexate for treatment of caesarean scar pregnancy. Br J Obstet Gynaecol 117:990–996CrossRef
7.
Zurück zum Zitat Cao S, Zhu L, Lin L et al (2014) Uterine artery embolization in cesarean scar pregnancy: safe and effective intervention. Chin Med J (Engl) 127(12):2322–2326 Cao S, Zhu L, Lin L et al (2014) Uterine artery embolization in cesarean scar pregnancy: safe and effective intervention. Chin Med J (Engl) 127(12):2322–2326
8.
Zurück zum Zitat Özkan S, Çaliskan E, Özeren S et al (2007) Three-dimensional ultrasonographic diagnosis and hysteroscopic management of a vialle cesarean scar ectopic pregnancy. J Obstet Gynaecol 33:873–877 Özkan S, Çaliskan E, Özeren S et al (2007) Three-dimensional ultrasonographic diagnosis and hysteroscopic management of a vialle cesarean scar ectopic pregnancy. J Obstet Gynaecol 33:873–877
9.
Zurück zum Zitat Litwicka K, Greco E (2013) Caesarean scar pregnancy: a review of management options. Curr Opin Obstet Gynecol 25(6):456–461CrossRefPubMed Litwicka K, Greco E (2013) Caesarean scar pregnancy: a review of management options. Curr Opin Obstet Gynecol 25(6):456–461CrossRefPubMed
10.
Zurück zum Zitat Hosni MM, Herath RP, Mumtaz R (2014) Diagnostic and therapeutic dilemmas of cervical ectopic pregnancy. Obstet Gynecol Surv 69:261–276CrossRefPubMed Hosni MM, Herath RP, Mumtaz R (2014) Diagnostic and therapeutic dilemmas of cervical ectopic pregnancy. Obstet Gynecol Surv 69:261–276CrossRefPubMed
11.
Zurück zum Zitat Van Mello NM, Mol F, Ankum WM et al (2012) Ectopic pregnancy: how the diagnostic and therapeutic management has changed. Fertil Steril 98:1066–1073CrossRefPubMed Van Mello NM, Mol F, Ankum WM et al (2012) Ectopic pregnancy: how the diagnostic and therapeutic management has changed. Fertil Steril 98:1066–1073CrossRefPubMed
12.
Zurück zum Zitat Guvenag Guven ES, Dilbaz S, Dilbaz B et al (2010) Comparison of single and multiple dose methotrexate therapy for unruptured tubal ectopic pregnancy: a prospective randomized study. Acta Obstet Gynecol Scand 89:889–895CrossRef Guvenag Guven ES, Dilbaz S, Dilbaz B et al (2010) Comparison of single and multiple dose methotrexate therapy for unruptured tubal ectopic pregnancy: a prospective randomized study. Acta Obstet Gynecol Scand 89:889–895CrossRef
13.
Zurück zum Zitat Muraji M, Mabuchi S, Hisamoto K et al (2009) Cesarean scar pregnancies successfully treated with methotrexate. Acta Obstet Gynecol Scand 88:720–723CrossRefPubMed Muraji M, Mabuchi S, Hisamoto K et al (2009) Cesarean scar pregnancies successfully treated with methotrexate. Acta Obstet Gynecol Scand 88:720–723CrossRefPubMed
14.
Zurück zum Zitat Bayoglu Tekin Y, Mete Ural U, Balık G et al (2014) Management of cesarean scar pregnancy with suction curettage: a report of four cases and review of the literature. Arch Gynecol Obstet 289:1171–1175CrossRefPubMed Bayoglu Tekin Y, Mete Ural U, Balık G et al (2014) Management of cesarean scar pregnancy with suction curettage: a report of four cases and review of the literature. Arch Gynecol Obstet 289:1171–1175CrossRefPubMed
15.
Zurück zum Zitat Wang H, Garmel S (2003) Successful term pregnancy after bilateral uterine artery embolization for postpartum hemorrhage. Obstet Gynecol 102:603–604PubMed Wang H, Garmel S (2003) Successful term pregnancy after bilateral uterine artery embolization for postpartum hemorrhage. Obstet Gynecol 102:603–604PubMed
16.
Zurück zum Zitat Marcus S, Cheng E, Goff B (1999) Extrauterine pregnancy resulting from early uterine rupture. Obstet Gynecol 94:804–805PubMed Marcus S, Cheng E, Goff B (1999) Extrauterine pregnancy resulting from early uterine rupture. Obstet Gynecol 94:804–805PubMed
17.
Zurück zum Zitat Qian ZD, Huang LL, Zhu XM (2015) Curettage or operative hysteroscopy in the treatment of cesarean scar pregnancy. Arch Gynecol Obstet 292:1055–1061CrossRefPubMed Qian ZD, Huang LL, Zhu XM (2015) Curettage or operative hysteroscopy in the treatment of cesarean scar pregnancy. Arch Gynecol Obstet 292:1055–1061CrossRefPubMed
18.
Zurück zum Zitat Gao L, Huang Z, Gao J et al (2014) Uterine artery embolization followed by dilation and curettage within 24 hours compared with systemic methotrexate for cesarean scar pregnancy. Int J Gynaecol Obstet 127:147–151CrossRefPubMed Gao L, Huang Z, Gao J et al (2014) Uterine artery embolization followed by dilation and curettage within 24 hours compared with systemic methotrexate for cesarean scar pregnancy. Int J Gynaecol Obstet 127:147–151CrossRefPubMed
20.
Zurück zum Zitat Practice Committee of American Society for Reproductive Medicine (2013) Medical treatment of ectopic pregnancy: a committee opinion. Fertil Steril 100:638–644CrossRef Practice Committee of American Society for Reproductive Medicine (2013) Medical treatment of ectopic pregnancy: a committee opinion. Fertil Steril 100:638–644CrossRef
21.
Zurück zum Zitat Oron G, Tulandi T (2013) A pragmatic and evidence-based management of ectopic pregancy. J Minim Invasive Gynecol 20:446–454CrossRefPubMed Oron G, Tulandi T (2013) A pragmatic and evidence-based management of ectopic pregancy. J Minim Invasive Gynecol 20:446–454CrossRefPubMed
22.
Zurück zum Zitat Tomislav S, Josip M, Liana CS et al (2011) Uterine artery embolization as nonsurgical treatment of uterine myomas. ISRN Obstet Gynecol 2011:489281CrossRefPubMedPubMedCentral Tomislav S, Josip M, Liana CS et al (2011) Uterine artery embolization as nonsurgical treatment of uterine myomas. ISRN Obstet Gynecol 2011:489281CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Zakaria MA, Abdallah ME, Shavell VI et al (2011) Conservative management of cervical ectopic pregnancy: utility of uterine artery embolization. Fertil Steril 95:872–876CrossRefPubMed Zakaria MA, Abdallah ME, Shavell VI et al (2011) Conservative management of cervical ectopic pregnancy: utility of uterine artery embolization. Fertil Steril 95:872–876CrossRefPubMed
24.
Zurück zum Zitat Ben Naqi J, Helmy S, Ofili-Yebovi D et al (2007) Reproductive outcomes of women with a previous history of cesarean scar ectopic pregnancies. Hum Reprod 22:2012–2015CrossRef Ben Naqi J, Helmy S, Ofili-Yebovi D et al (2007) Reproductive outcomes of women with a previous history of cesarean scar ectopic pregnancies. Hum Reprod 22:2012–2015CrossRef
25.
Zurück zum Zitat Maymon R, Svirsky R, Smorgick N et al (2011) Fertility performance and obstetric outcomes among women with previous cesarean scar pregnancy. J Ultrasound Med 30:1179–1184PubMed Maymon R, Svirsky R, Smorgick N et al (2011) Fertility performance and obstetric outcomes among women with previous cesarean scar pregnancy. J Ultrasound Med 30:1179–1184PubMed
26.
27.
Zurück zum Zitat Zhang B, Jiang ZB, Huang MS et al (2012) Uterine artery embolization combined with methotrexate in the treatment of cesarean scar pregnancy: results of a case series and review of the literature. J Vasc Interv Radiol 23:1582–1588CrossRefPubMed Zhang B, Jiang ZB, Huang MS et al (2012) Uterine artery embolization combined with methotrexate in the treatment of cesarean scar pregnancy: results of a case series and review of the literature. J Vasc Interv Radiol 23:1582–1588CrossRefPubMed
Metadaten
Titel
Uterine artery embolization combined with curettage vs. methotrexate plus curettage for cesarean scar pregnancy
verfasst von
Wei Liu
Liang Shen
Qingwen Wang
Wei Wang
Zengtao Sun
Publikationsdatum
18.11.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Archives of Gynecology and Obstetrics / Ausgabe 1/2016
Print ISSN: 0932-0067
Elektronische ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-015-3952-2

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