Risk Factors Of Massive Vaginal Bleeding During Uterine Artery Embolization Combined With Curettage For The Treatment Of A Caesarean Scar Pregnancy

ObjectiveTo analyze the high risk factors of massive vaginal bleeding during uterine artery embolization(UAE) combined with curettage for the treatment of a caesarean scar pregnancy(CSP).Materials and MethodsFrom Jan.2003 to Dec.2012,576 cases with CSP treated by UAE combined with curettage were studied retrospectively in Women’s Hospital, School of Medicine, Zhejiang University.551 patients in Group A (blood loss<500ml), while 25 patients in Group B (blood loss≥500ml). Age, gravidity and parity, number of previous caesareans and abortions, gestational age, diameter of CSP mass, previous hCG level, clinical types and whether fetal heart beat positive, myometrial thickness anterior to the CSP were documented. Univariate analysis and Logistic analysis were applied to analyze these data to assess the risk factors of hemorrhage during UAE combined with curettage.ResultsUnivariate analysis showed:There were no statistically differences in age, gravidity and parity, number of previous caesareans and abortions, clinical types and number of alive fetus in two groups(P>0.05); There were significant difference between Group A(7.9±2.8) and Group B(10.5±3.3) in gestational week(P<0.05),for gestational week>8, it was statistically different[33.3% vs 80%, P<0.05];Diameter of CSP mass in two groups were significantly different[(3.14±1.67)cm vs (6.07±2.28)cm, P<0.05],for diameter mass of CSP>6cm, there were differences in two groups[6.4% vs 48%, P<0.05].Myometrial thickness anterior to the CSP in two groups were[(0.22±0.13) cm vs (0.16±0.99) cm, P<0.05)].Logistic analysis showed that during UAE combined with curettage, the odds ratio(OR) of gestational week>8 between two groups was 5.210(95% confidence interval[CI] 1.787-15.193, p=0.011), and the OR of the diameter of CSP mass>6cm between was 5.63(95CI1.495-21.228).ConclusionUAE combined with curettage is a safe and effective treatment for CSP. However, the risk of massive bleeding after this treatment is much higher for the patients whose gestational week is more than 8 weeks and the diameter of CSP mass is more than 6 cm.