Comparison of Curettage and Hysteroscopy Plus Curettage After Uterine Arterial Embolization in the Treatment of Cesarean Scar Pregnancy
Background: Caesarean scar pregnancy (CSP) stands for the advanced stage severe complication secondary to cesarean section, and its incidence shows an increasing trend recently. However, no consensus has been reached about the optimal CSP treatment. Methods: The childbearing CSP patients with a cesarean section history were evaluated by ultrasonography, with a gestational age of less than 10 weeks. 34 patients receiving dilation and curettage (D&C) and uterine artery embolization (UAE) were
... tion (UAE) were enrolled into the D&C group, while 46 undergoing hysteroscopy (H/S) and D&C after UAE were enrolled into the H/S+D&C group. Results: Differences in success rate and decrease in the β-hCG level in serum on the second day of surgery were not significant between D&C and H/S+D&C groups (P>0.05). Also, differences in side effect rate, intraoperative blood loss amount, postoperative bleeding time, and total length of stay were not significant between both groups (P>0.05). Compared with D&C group, H/S+D&C group had decreased postoperative length of stay (P<0.05), increased hospitalization cost (P<0.05), and significantly elevated time of CSP mass disappearance (P<0.05). In addition, 8 (18.19%) patients in H/S+D&C group developed anesthesia-related side effects.Conclusions:This study reveals no obvious difference between UAE+D&C and H/S+D&C in terms of the clinical efficacy and safety, except for the time of CSP mass disappearance. The hospitalization cost is more expensive for H/S+D&C, but the postoperative length of stay is shorter for H/S+D&C. Besides, H/S+D&C is associated with the risk of anesthesia-associated side effects. All these will affect the selection of patients for the two methods.