Bilateral uterine artery chemoembolization with methotrexate for cesarean scar pregnancy
ABSTRACT The objective of the study was to assess the efficacy of uterine arteries embolization (UAE) for the treatment of cesarean scar pregnancies (CSP).
Forty-six women with CSP were identified between March 2008 and March 2010. All of the patients underwent UAE combined with local methotrexate.
Forty-five patients were successfully treated. One patient had an emergency hysterectomy after 20 days because of massive vaginal hemorrhage. The mean time until normalization of serum β-human chorionic gonadotrophin was 37.7 days, and the mean time until CSP mass disappearance was 33.3 days. The mean hospitalization time was 10.5 days. The complications were mainly fever and pain, which were alleviated with symptomatic treatment. All 45 patients had recovered their normal menstruation at follow-up.
Bilateral uterine artery chemoembolization with methotrexate appears to be a safe and effective treatment for CSP and causes less morbidity than current approaches.
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ABSTRACT: To discuss the feasibility and safety of uterine artery chemoembolization in treating cesarean scar pregnancy (CSP). During the period between 1(st) of May 2009 and 17(th) of January 2014, uterine artery chemoembolization with methotrexate (MTX) and gelatin sponge was performed in 31 patients diagnosed with CSP in Xinqiao Hospital. Curettage of uterus was carried out within 24-48 hours after the procedure. The success rate of bilateral uterine artery chemoembolization was 100%. The mean blood loss during curettage procedure was only 8.32±4.76 (2-20) ml. The mean time for serum β-HCG normalization was 33.81±17.47 (15-82) days, and the mean time for gestational sacs elimination was 29.52±20.93 (4-90) days. The mean time of hospital stay was 5.10±1.08 (4-8) days. No serious complications occurred. The uterine artery chemoembolization is an effective and safe treatment for CSP, which greatly reduces the necessity of hysterectomy.International Journal of Clinical and Experimental Medicine 01/2015; 8(2):2570-7. · 1.42 Impact Factor
Article: Caesarean scar pregnancy[Show abstract] [Hide abstract]
ABSTRACT: Purpose of review The current review aims to provide an overview of the already available and emerging treatment modalities for caesarean scar pregnancy (CSP). Recent findings CSP is a type of ectopic gestation associated with a high risk of serious complications. The cause of this condition and the best management are still unclear. However, some medical and surgical treatment modalities have been suggested. The main objectives in the clinical management of CSP should be the prevention of massive blood loss and the conservation of the uterus to maintain further fertility, women's health and quality of life. Current data suggest that expectant management should not be recommended, whereas there are accumulating data suggesting that early diagnosis offers single or combined medical and surgical treatment options avoiding uterine rupture and haemorrhage, thus preserving the uterus and fertility. Summary No universal treatment guidelines for management of CSP have been published up to now. The lack of data on the best evidence should encourage any individual case report and further multicentre studies for recommendation establishment.Current Opinion in Obstetrics and Gynecology 01/2013; 25(6):456-461. DOI:10.1097/GCO.0000000000000023 · 2.37 Impact Factor
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ABSTRACT: To offer a therapeutic management of cesarean scar pregnancies (GSC) in the first trimester of pregnancy with a first approach by uterine artery embolization (UAE) PATIENTS AND METHODS: This study describes seven cases of GSC diagnosed between 2009 and 2013 in the clinic of the University Hospital of the Hospital of Croix-Rousse. We present the symptoms and how imagery has led to the diagnosis and the therapeutic management conducted. The mean gestational age at diagnosis was 9 weeks gestation. There were ongoing pregnancies with cardiac activity present for each patient. An additional MRI was performed in five patients. Five patients were treated with methotrexate injection, two patients received the Mifegyne. All patients then received a selective uterine artery embolization. Finally within 48hours, suction curettage was performed in 6 patients. A patient at 13 WA+1 required a subtotal hysterectomy for placenta accreta. Intra-operative complications were represented by a bladder injury, two bleeding of 1000mL in patients at 13 WA+1 and 12 WA. For the 6 cases of GSC with a gestational age less than 10 WA, average blood loss was less than 500mL. Three patients underwent resection of scar isthmocele confirmed by EVAC. An intrauterine pregnancy was carried to term after care. Cesarean scar pregnancies is a diagnostic and therapeutic challenge, which should be diagnosed as early as soon as possible with care in a medical facility with a uterine artery embolization technical platform. Our protocol combining Mifegyne and methotrexate for termination of pregnancy and uterine artery embolization (UAE) followed by curettage for evacuation of pregnancy allows conservative treatment while minimizing the risk of bleeding (for GSC diagnosed before 10 WA). Copyright © 2015 Elsevier Masson SAS. All rights reserved.Gynécologie Obstétrique & Fertilité 02/2015; DOI:10.1016/j.gyobfe.2015.01.015 · 0.58 Impact Factor