Uterine Artery Embolization With Or Without Methotrexate For Cesarean Section Scar Pregnancy

BACKGROUND: It is mainly a study between the therapies of uterine artery embolization combined with dilatation and curettage with methotrexate and without it in the cesarean section scar pregnancy.METHODS: During the period of Jan.2009-May.2015,73 patients with cesarean section pregnancy are chosen in the study.One group with 30 patients is performed with uterine artery chemoembolization(MTX group).The other group with 44 patients is performed with purely embolization without methotrexate.after the a short time,except for the 3 patients in the MTX group,all of the remaining 27 patients of the MTX group and 44 patients of the purely group took the dilatation and curettage.After the uterine artery embolization with or without methotrexate,the serum human chorionic gonadotropin(?-h CG)should be regularly observed until it decreased to the normal level.It is compared between these two groups by the decrease speed of ?-h CG,blood loss,hospitalization days and the recovery of menstruation.Otherwise,we followup the patients after a year for their gynecologic al and pregnancy conditions.RESULTS: In this research of 73 cases of cesarean scar pregnancy,30 cases of them are in the MTX chemoembolization group,and the other 43 cases are in the embolization group.On the operation day of UAE,the serum ?-h CG level decreases faster in chemolization group.On the 3rd day after the UAE day,their decreasing speed doesn't make a statistical difference.There are 6 patients whose blood loss is over 500 ml.4 of them belong to the chemoembolization group.2 of them are in the embolization group.Both of these two group doesn't have a statistical difference in recovery time of menstrual cycle.After the latest followup,there are 5 of them pregnant again.3 of them had already took the cesarean section to bear the baby.1 is in the chemoembolization group.The other 2 is in the embolization group.The remaining 1 is ongoing.The last 1 is not certain about the fetal heart and place.CONCLUSIONS: The efficacy between the embolization group and the chemoembolization group for the cesarean scar pregnancy are almost the same.The advantage of the MTX chemoembolizaiton is the possibility of interventional therapy.A second pregnancy is probably due to individual difference much more.