Clinical Study Of Uterine Artery Embolization In The Treatment Of Scar Pregnancy After Cesarean Section On Ovarian Function

Objective:With the gradual liberalization of China’s fertility policy,the rate of cesarean section is getting higher,and the incidence of scar pregnancy(CSP)after cesarean section is also increasing.The muscle elasticity of the uterine scar decreases or disappears.With the continuous increase of the gestational age,the pregnancy tissue gradually intensifies,and the tension on the uterine wall gradually increases.It is easy to cause the rupture of the uterine wall myometrium and cause hemorrhage.The effective treatment for CSP is whether it can be diagnosed in time,and the pregnancy can be terminated in time for preventing hemorrhage.In recent years,uterine artery embolization(UAE)combined with uterine evacuation has been widely used in clinical practice,and the effect of treating CSP has been clinically confirmed.However,due to the anatomical relationship between uterine arteries and ovarian branches,whether it will damage the ovaries and adversely affect ovarian function after UAE is controversial.Therefore,this article aims to compare the effects of UAE combined with uterine evacuation and laparoscopic scar pregnancy resection(LCSPDS)on the prognosis and ovarian function of two different treatment options,and to provide a clinical theoretical basis for the treatment of CSP by uterine artery embolization.METHODS: Through the collection of 53 CSP patients admitted to Wuhu First People’s Hospital from January 2018 to August 2020,according to the different treatment options independently selected by the patients and their families,they were divided into a study group(25 cases)and a control group(28 cases).The treatment plan chosen by the patients in the study group was uterine evacuation with ultrasound positioning after UAE;the patients in the control group chose laparoscopic scar pregnancy lesion resection + uterine wall repair surgery.The differences in the duration of surgery,blood loss,hospitalization time,menstrual re-fluid time,dynamic changes of blood β-HCG,and changes in ovarian reserve(AMH,LH,FSH,E2)were compared between the two groups.The efficacy of UAE in the treatment of CSP patients and its influence on ovarian function were further explained..Results: The age,time of menopause,time from cesarean section,body mass index(BMI),CSP type ratio,gestational sac size,alanine aminotransferase(ALT),aspartate aminotransferase(AST),prothrombin time(PT),activated partial thromboplastin time(APTT),platelets(PLT),etc,were not significantly different,not statistically significant(P>0.05),and they were comparable.The duration of surgery,blood loss,hospitalization time,and menstrual renewal time in the study group were less than those in the control group,with statistical differences(P<0.05).The preoperative bloodβ-HCG levels of the two groups were not significantly different(P>0.05).The postoperative blood β-HCG of the study group had a significant decline compared with the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the changes of E2,FSH,and LH between the study group and the control group before and one week after the operation and one month after the operation(P>0.05);The monthly comparison was statistically significant(P<0.05);there was no statistically significant difference between one month after the operation and before the operation(P>0.05);the control group had no difference between AMH one week after the operation and one month after the operation before the operation.Statistical significance(P>0.05).Conclusions: 1.Uterine evacuation after UAE has advantages in terms of operating time,intraoperative blood loss,and postoperative recovery compared with laparoscopic scar pregnancy removal.After UAE,the treatment success rate of uterine curettage is basically the same as that of laparoscopic scar pregnancy lesion resection.2.UAE has no effect on the patient’s ovarian reserve function,and has no obvious adverse effect on the re-pregnancy.Therefore,UAE combined with uterine evacuation is worthy of active promotion and application in CSP patients.