Retrospective study of patients with cesarean scar pregnancies treated by uterine artery chemoembolization and curettage

Objective: To evaluate the efficacy and long-term prognosis of uterine artery chemoembolization (UACE) combined with curettage for treatment of cesarean scar pregnancy (CSP). Methods: Data were retrospectively reviewed from women with CSPs treated by UACE with curettage at Women's Hospital of Zhejiang University, Hangzhou, a tertiary obstetrics and gynecologic center in China, between December 2006 and December 2016. Information on clinical characteristics and treatment outcomes was obtained from medical records and follow-up interviews. Results: There were 383 patients included; 379 (99.0%) women were successfully treated. Risk factors associated with intraoperative bleeding were size of gestational mass (P=0.001), presence of fetal heart beat (P=0.002), and type of CSP (P=0.002). Among 301 women with complete medical records over a mean +/- SD follow-up of 49.8 +/- 30.2 months, 164 (54.5%) women resumed normal menstruation and only 22 (7.3%) experienced a reduction in menstrual volume of more than one-half. Among 89 women attempting to conceive, the conception rate was 69% (61/89), the positive pregnancy rate was 80% (49/61), and 35 live neonates were delivered. Conclusion: UACE combined with curettage was found to be an effective fertility-sparing treatment for CSP. Further, the approach did not seem to harm future reproductive ability.