The application of uterine artery embolization for the treatment of uterine scar pregnancy after cesarean section

Objective To assess the clinical value of uterine arterial embolization(UAE) in treating uterine scar pregnancy after cesarean section.Methods A total of 35 cases with cesarean scar pregnancy,admitted to authors' hospital during the period from Jan.2007 to June 2011,were divided into two groups: embolization group(n = 21) and non-embolization group(n = 14).By using Seldinger technique,UAE was performed via the right femoral access and gelatin sponge particle was used as embolization agent to occlude the uterine artery.In embolization group,sixteen patients received uterine cavity curettage one or two days after UAE,while five patients received laparotomy or perineotomy surgery to remove the lesions after UAE.In non-embolization group,uterine cavity curettage was performed directly in 8 patients,local injection of methotrexate followed by uterine cavity curettage was carried out in 3 patients,and direct laparotomy to remove the lesions was adopted in the remaining 3 patients.The blood loss during the procedure,the hospitalization days and the time for β-HCG levels falling to normal were documented.The results were compared between the two groups.Results UAE was successfully accomplished in all the 21 patients of embolization group and the uterus was preserved in all patients.For the embolization group,the mean hospitalization time was(11.5 ± 3.6)days,and the time for β-HCG levels falling to normal was(18.6 ± 4.9) days.For the non-embolization group,the mean hospitalization time was(20.4 ± 5.2)days,and the time for β-HCG levels falling to normal was(28.7 ± 5.6)days.Hysterectomy had to be carried out in two patients of non-embolization group due to the massive bleeding occurred in therapeutic procedures.Conclusion For the treatment of cesarean scar pregnancy,UAE is very effective and mini-invasive with high success rate.UAE can preserve the patient's reproductive function,and it also plays a significant role in preventing hemorrhage and assisting hemostasis.