Application of the Uterine Artery Infusion Embolization combined with Curettage in the Treatment of Cesarean Scar Pregnancy

LIU Li; LIU Yu; ZHANG Hong

Abstract：Objective: To analyze the therapeutic effect and safety of the uterine artery infusion embolism (UAIE) combined with curettage in the treatment of cesarean scar pregnancy (CSP). Methods:A total of 61 CSPⅡpatients who underwent UAIE combined with curettage within 48 hours were retrospectively analyzed, from March 2010 to October 2015, in our hospital. The indexes such as operative time, intraoperative blood loss,postoperative incidence of adverse reactions and postoperative human chorionic gonadotropin (β-hCG) level were recorded. Results: ①All patients were punctured and intervented successfully. There were 32 cases with abdominal pain, 5 cases with fever and 7 cases with hip pain. ②In those 61 cases, the effective rate of intervention treatment was 91.8% (56 cases were cured and 5 cases failed). Three cases had massive vaginal bleeding in their curettage,in which one case was converted to laparotomy. The intervention treatment failed in 1 case who occured massive vaginal bleeding after 28 days of intervention and 3 cases with persistent ectopic pregnancy. ③The average hospitalization expenses were (9 235 ±325) RMB; ④Those cases were divided into 4 groups according to the decline level of β-hCG after intervention treatment. All of 20 patients with the decreased level of β-hCG more than 75%were cured (Group 1). In those 29 cases with the decreased level ofβ-hCG within 50%-75%(Group 2), 3 cases had persistent ectopic pregnancy, and 1 cases whose β-hCG level was up to 236 064 IU/L before treatment was failed. In 10 cases with the decreased level of β-hCG within 25%-50% (Group 3), 4 cases had persistent ectopic pregnancy, and 2 cases were failed;only 1 case with the decreased level of β-hCG less than 25%(Group 4) was converted to operation. Conclusions: The UAIE combined with curettage in the treatment of CSP is safe and effective. The decreased level of β-hCG after intervention treatment can be used as one of parameters to predict the prognosis. The greater the declined level of β-hCG, the better the prognosis. Those patients with a small decreased level of β-hCG were more likely to have persistent ectopic pregnancy, which suggested that they should be monitored after intervention treatment.