title: Caesarean scar pregnancy: treatment with bilateral uterine artery chemoembolization combined with dilation and curettage.
abstract: OBJECTIVE
  This study investigated bilateral uterine artery chemoembolization (BUACE) combined with dilation and curettage (D&C) in caesarean scar pregnancy (CSP).
  
  
  METHODS
  Nineteen women with CSP were referred for interventional radiology. In 13 patients, BUACE was performed before D&C, following a diagnosis of CSP. A further six patients received BUACE for massive vaginal bleeding after D&C for inevitable miscarriage; the diagnosis of CSP was subsequently confirmed ultrasonographically. BUACE of the uterine arteries was performed using gelfoam particles following intra-arterial infusion of 100 mg/m(2) methotrexate.
  
  
  RESULTS
  BUACE was technically successful and immediate haemostasis was achieved in all patients. Blood loss was significantly greater during D&C undertaken before BUACE compared with D&C after BUACE, but this bleeding was controlled by BUACE. No patient required further surgical intervention and there were no severe complications. The gestational sac and placenta could no longer be detected ultrasonographically and the menstrual cycle returned to normal 2-3 months after treatment in all patients.
  
  
  CONCLUSIONS
  BUACE followed by D&C seems to be a safe and effective treatment for CSP and should be considered as a treatment of choice.
authors.affiliation: Department of Interventional Radiology, Renji Hospital, Shanghai JiaoTong University Medical School, Shanghai, China.
authors.forename: X-B
authors.initials: XB
authors.lastname: Zhang
authors.forename: Y-C
authors.initials: YC
authors.lastname: Zhong
authors.forename: J-C
authors.initials: JC
authors.lastname: Chi
authors.forename: J-L
authors.initials: JL
authors.lastname: Shen
authors.forename: X-X
authors.initials: XX
authors.lastname: Qiu
authors.forename: J-R
authors.initials: JR
authors.lastname: Xu
authors.forename: A-M
authors.initials: AM
authors.lastname: Zhao
authors.forename: W
authors.initials: W
authors.lastname: Di
mesh_terms: D000328:Adult; D002585:Cesarean Section; D016461:Chemoembolization, Therapeutic; D002921:Cicatrix; D003131:Combined Modality Therapy; D004107:Dilatation and Curettage; D005260:Female; D006801:Humans; D009215:Myometrium / Q000000981:diagnostic imaging / Q000473:pathology; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome; D014463:Ultrasonography; D055988:Uterine Artery / Q000473:pathology; D014592:Uterine Hemorrhage / Q000628:therapy; D014599:Uterus / Q000098:blood supply / Q000601:surgery; D055815:Young Adult