Bilateral Uterine Artery Chemoembolization Terminates Cesarean Scar Pregnancy

October 04, 2012

By Will Boggs

NEW YORK (Reuters Health) Oct 02 - Bilateral uterine artery chemoembolization with methotrexate safely and effectively terminates cesarean scar pregnancy (CSP), a new study has found.

"Our purpose is to show that uterine artery embolization is a safe way to treat CSP in clinical practice," Dr. Wei Huang from West China Second University Hospital of Sichuan University, Chengdu told Reuters Health. "But we (cannot say) it is a standard treatment for this disorder."

Cesarean scar pregnancies, which account for around 6% of all ectopic pregnancies with a history of at least one cesarean section, can lead to life-threatening hemorrhage, uterine rupture, disseminated intravascular coagulation, and death.

Management has included hysterectomy, local resection of the gestational mass within the previous cesarean scar, dilation and curettage, and administration of various drugs (including methotrexate) -- but how best to treat CSP remains uncertain.

Dr. Huang and colleagues reviewed data on 46 women with CSP managed with bilateral uterine arterial chemoembolization.

Twenty-five of the women were initially diagnosed with CSP on admission to their hospital. These women underwent chemoembolization as primary treatment, followed 72 hours later by suction curettage. Serum levels of beta-human chorionic gonadotropin (hCG) returned to normal in an average 32.0 days; total lesion disappearance took an average 32.7 days. All these women experienced a rapid, uneventful recovery, according to the authors.

The other 21 women were transferred to their hospital after massive hemorrhage during suction curettage at their first visit to other hospitals. They underwent bilateral uterine artery chemoembolization, followed by suction curettage 72 hours later in 11 women for persistent vaginal bleeding and/or a persistent gestational mass larger than 5 cm.

The times to normalization of beta-hCG and total lesion disappearance were somewhat longer in these 21 women, according to a report online September 19 in the American Journal of Obstetrics and Gynecology.

The overall success rate was 97.8% (45/46). One woman returned 20 days after chemoembolization with massive acute vaginal bleeding and required a life-saving emergency subtotal hysterectomy.

Of the remaining 45 women, 22 had restoration of normal menses a month later, three had regular menses three months later, 16 experienced menstrual disorders of reduced menstrual amounts, and the remaining four experienced dysmenorrhea.

All 45 women had normal menstrual cycles without dysmenorrhea at last follow-up.

"Although these data are encouraging," the researchers say, "further randomized trials will be necessary to compare the effect of embolization with and without methotrexate."

"The next step we shall do is to follow these women to investigate their further ovarian function or fertility," Dr. Huang said. "And we shall collect more data to help us to treat (CSP) safely and effectively."


Am J Obstet Gynecol 2012.