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Bohiltea R, Ducu I, Mihai B, et al. Uterine Artery Embolization Combined with Subsequent Suction Evacuation as Low-Risk Treatment for Cesarean Scar Pregnancy. Diagnostics (Basel). 2021;11(12)doi: 10.3390/diagnostics11122350.
Bohiltea, R., Ducu, I., Mihai, B., Iordache, A. M., Dorobat, B., Vladareanu, E. M., Iordache, S. M., Bohiltea, A. T., Bacalbasa, N., Grigorescu, C. E. A., & Varlas, V. (2021). Uterine Artery Embolization Combined with Subsequent Suction Evacuation as Low-Risk Treatment for Cesarean Scar Pregnancy. Diagnostics (Basel, Switzerland), 11(12), . https://doi.org/10.3390/diagnostics11122350
Bohiltea, Roxana, et al. "Uterine Artery Embolization Combined with Subsequent Suction Evacuation as Low-Risk Treatment for Cesarean Scar Pregnancy." Diagnostics (Basel, Switzerland) vol. 11,12 (2021). doi: https://doi.org/10.3390/diagnostics11122350
Bohiltea R, Ducu I, Mihai B, Iordache AM, Dorobat B, Vladareanu EM, Iordache SM, Bohiltea AT, Bacalbasa N, Grigorescu CEA, Varlas V. Uterine Artery Embolization Combined with Subsequent Suction Evacuation as Low-Risk Treatment for Cesarean Scar Pregnancy. Diagnostics (Basel). 2021 Dec 14;11(12). doi: 10.3390/diagnostics11122350. PMID: 34943587.
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Diagnostics (Basel). 2021 Dec 14;11(12). doi: 10.3390/diagnostics11122350.

Uterine Artery Embolization Combined with Subsequent Suction Evacuation as Low-Risk Treatment for Cesarean Scar Pregnancy.

Diagnostics (Basel, Switzerland)

Roxana Bohiltea, Ionita Ducu, Bianca Mihai, Ana-Maria Iordache, Bogdan Dorobat, Emilia Maria Vladareanu, Stefan-Marian Iordache, Alexia-Teodora Bohiltea, Nicolae Bacalbasa, Cristiana Eugenia Ana Grigorescu, Valentin Varlas

Affiliations

  1. Discipline of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy Bucharest, 37 Dionisie Lupu, 020021 Bucharest, Romania.
  2. Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 169 Splaiul Independentei Bld., Sector 5, 050098 Bucharest, Romania.
  3. Department of Obstetrics and Gynecology, Filantropia Hospital, 11-13 Ion Mihalache Blv., Sector 1, 011171 Bucharest, Romania.
  4. Optospintronics Department, National Institute for Research and Development in Optoelectronics-INOE 2000, 409 Atomistilor, 077125 Magurele, Romania.
  5. Department of Interventional Radiology, University Emergency Hospital Bucharest, 169 Splaiul Independentei Bld., Sector 5, 050098 Bucharest, Romania.
  6. Department of Interventional Radiology, Life Memorial Hospital, 050098 Bucharest , Romania.
  7. Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy Bucharest, 37 Dionisie Lupu, 020021 Bucharest, Romania.
  8. École Hôtelière de Lausanne, 1000 Lausanne, Switzerland.

PMID: 34943587 DOI: 10.3390/diagnostics11122350

Abstract

OBJECTIVE: The aim of this study is to propose a standardized management of care for patients diagnosed with cesarean scar pregnancy (CSP). There are two types of CSP: Type 1 (on the scar) vs. type 2 (in the niche). To date there is no international standard to predict the extent of invasion or the optimal management of CSP.

MATERIALS AND METHODS: We used intramuscular methotrexate injection followed by uterine artery embolization combined with suction evacuation as a conservative approach for the treatment of seven patients diagnosed with CSP. Our inclusion criteria, to be satisfied simultaneously, were established as follows: (1) patients with CSP; (2) early gestational age ≤ 9 weeks, and (3) written consent of the proposed treatment of the patient.

RESULTS: This course of treatment produced a positive outcome in all cases. We did not have any complications (e.g., emergency hysterectomy, perforation of the uterine cavity, severe hemorrhage, or endometritis) during the procedures or in the follow-up. The most important predictors of successful management are early diagnosis of CSP and orientation of the invasive trophoblast opposite to the scar.

CONCLUSIONS: The main finding from this series of cases is that associating systemic methotrexate and uterine artery embolization provides efficient and low-risk management of CSP. This treatment regime is adequate for both types of CSPs. We consider that early localization diagnosis of pregnancy following a cesarean delivery is mandatory for CSP morbidity prevention.

Keywords: CSP registry; cesarean scar pregnancy; invasive placenta; uterine artery embolization

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