title: Uterine artery embolization followed by dilation and curettage within 24 hours compared with systemic methotrexate for cesarean scar pregnancy.
abstract: OBJECTIVE
  To assess the efficacy of uterine artery embolization (UAE) combined with dilation and curettage (D&C) within 24 hours for the treatment of a cesarean scar pregnancy (CSP), compared with methotrexate and D&C.
  
  
  METHODS
  A retrospective cohort study of 119 women with CSP was conducted at two tertiary hospitals in Guangzhou and Shenzhen, China, during 2009-2012. Twenty-six women received systemic methotrexate followed by D&C, and 93 women were treated with UAE followed by D&C within 24 hours.
  
  
  RESULTS
  Mean blood loss was 261.0±357.4 mL in the methotrexate group versus 14.1±40.6 mL in the UAE group (P<0.001). The time to resolution of the level of β-human chorionic gonadotropin was 40.5±17.2 days versus 15.4±7.7 days (P<0.001), respectively. The duration of hospitalization was 14.6±9.2 days versus 6.2±3.7 days (P<0.001), respectively. An additional intervention was needed in 9 (35%) women in the methotrexate group and in 5 (5%) in the UAE group (P<0.001).
  
  
  CONCLUSIONS
  UAE combined with D&C within 24 hours was an effective uterine preservation treatment for CSP, and was associated with less blood loss and a shorter hospital stay than administration of methotrexate followed by D&C.
authors.affiliation: Department of Gynecology and Obstetrics, The First Affiliated Hospital of Jinan University, Guangzhou, China.
authors.forename: LvFen
authors.initials: L
authors.lastname: Gao
authors.affiliation: Department of Obstetrics and Gynecology, National University Health Systems, Singapore.
authors.forename: Zhongwei
authors.initials: Z
authors.lastname: Huang
authors.affiliation: Department of Gynecology and Obstetrics, Shenzhen Women's and Children's Hospital, Shenzhen, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Gao
authors.affiliation: Department of Gynecology and Obstetrics, The First Affiliated Hospital of Jinan University, Guangzhou, China.
authors.forename: Haoshan
authors.initials: H
authors.lastname: Mai
authors.affiliation: Department of Gynecology and Obstetrics, The First Affiliated Hospital of Jinan University, Guangzhou, China.
authors.forename: Yiting
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Gynecology and Obstetrics, The First Affiliated Hospital of Jinan University, Guangzhou, China. Electronic address: freshlucy07@126.com.
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Wang
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D002585:Cesarean Section; D002681:China; D002921:Cicatrix; D004107:Dilatation and Curettage / Q000009:adverse effects; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007902:Length of Stay; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000188:drug therapy* / Q000601:surgery*; D012189:Retrospective Studies; D055357:Uterine Artery Embolization
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate
keywords: Cesarean scar pregnancy; Systemic methotrexate; Uterine artery embolization; Uterine curettage