The Application Research Of Uterine Artery Embolization For Cesarean Scar Pregnancy

Objective: To evaluate the value of uterine artery embolization in cesarean scar pregnancy, and to investigate the effective methods for cesarean scar pregnancy.Methods:According to treatment methods, 31 cases were classified into two groups: A and B. 15 patients of A group were underwent uterine artery embolization: Seldinger technology be used to puncture femoral artery ,and sheath be implanted. Cobra catheter was sent to the left uterine artery to angiography in order to understand the blood supply of lesions. And gelfoam particles was used to embolize uterine artery , after that , angiography was performed again to confirmed embolized completely. Then catheter was chose to right uterus artery, the same method was used to deal with it. Curettage resection was performed under untrasound guide 24-48 hours later. 16 patients of Group B first received methotrexate (50mg) injection and curettage resection was performed untilβ-HCG fall to nearly normal .Results: 15 patients of A group, curettage was performed after uterine artery embolization. The progress was successful, all cases did not happen massive hemorrhage and other serious complications. 16 patients of B group, 4 cases were performed uterine artery embolization because of massive hemorrhage during curettage. 3 patients with incompletely curettage(β-HCG did not fall)were performed lesions resection, 2 patients were performed UAE before lesions resection, the operation was successful,1 patients were performed lesions resection directly, and with massive hemorrhage be forced to resection uterine. Hemorrhage during curettage: group A was 30.0+ 40.0 ml, group B was 200.0 + 187.5 ml. Time ofβ-HCG reduced to normal: A group was 21.0 + 5.0 days, group B was 41.5 + 13.3 days. Hospital stays: A group was 13.5±4.7days, B group was 27.6 + 8.8 days. Compared A, B group of hemorrhage,time ofβ-HCG reduced to normal and hospital stays, p < 0.05, the difference did not have statistically significant. FSH, LH and E₂ of A group was monitored before UAE and 1 months after UAE , of which 3 cases were lost to monitor. Before UAE the FSH, LH, E₂was 12.06±4.43 IU / L, 14.95±4.70 IU / L, 3.93±0.67 ng / ml. After UAE the FSH, LH, E₂ was 13.65±4.96 IU / L, 15.39±6.47IU / L, 4.25±0.97 ng / ml, paired t test was used, P> 0.05,the difference did not have statistically significant.Conclusion: Uterine artery embolization combined with curettage is a effective method for cesarean section scar pregnancy. It can significantly reduce the hemorrhage of curettage, shorten the time ofβ-HCG reduced to normal and shorten hospital stays. It was also non-trauma, high success rate and retained reproductive function. For massive hemorrhage during curettage, uterine artery embolization is also a kind of effective hemostatic measures. UAE can hemostasis quickly, save patients ' life and provided the opportunity for other treatments.