title: Combined laparoscopy and hysteroscopy vs. uterine curettage in the uterine artery embolization-based management of cesarean scar pregnancy: a cohort study.
abstract: OBJECTIVE
  To evaluate the efficacy of combined laparoscopy and hysteroscopy compared with traditional uterine curettage in removing the ectopic conceptus and repairing the tissue defect following uterine artery embolization (UAE) management of cesarean scar pregnancy (CSP).
  
  
  METHODS
  A prospective cohort study.
  
  
  METHODS
  Three large obstetrics and gynecology centers in Shanghai, China.
  
  
  METHODS
  CSP patients diagnosed between March 2009 and August 2010 who had received no prior treatments, were hemodynamically stable, and had no contraindications for UAE were enrolled.
  
  
  METHODS
  Patients were divided into two cohorts to undergo the intra-arterial methotrexate (MTX), UAE, and one of the following treatments: combined laparoscopy and hysteroscopy (research group, 25 cases) and uterine curettage (control group, 33 cases).
  
  
  METHODS
  The conceptus removal rate, the severity of intra- and postoperative complications, surgical time, and duration of hospital stay.
  
  
  RESULTS
  The single-surgery conceptus removal rate reached 100% in the research group, which was significantly higher than the 82% (P=0.024) observed in the control group (with one hysterectomy). The average volume of intraoperative blood loss was 78.0 mL in the research group, which was much less than the 258.5 mL (P=0.004) in the control group. Moreover, the research group had significantly shorter hospital stays and β-hCG regression times, as well as lower rates of postoperative abdominal pain, uterine bleeding and menstruation abnormalities.
  
  
  CONCLUSIONS
  Combined laparoscopy and hysteroscopy is much safer and more effective than uterine curettage as a supplementary measure following UAE.
authors.affiliation: Key Laboratory of Female Reproductive Endocrine Related Diseases, Obstetrics and Gynecology Hospital, Fudan University Shanghai, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Wu
authors.affiliation: Key Laboratory of Female Reproductive Endocrine Related Diseases, Obstetrics and Gynecology Hospital, Fudan University Shanghai, China.
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Xue
authors.affiliation: Department of Gynecology, First Maternity and Infant Health Hospital, Tongji University Shanghai, China.
authors.forename: Xuezhe
authors.initials: X
authors.lastname: Wu
authors.affiliation: Key Laboratory of Female Reproductive Endocrine Related Diseases, Obstetrics and Gynecology Hospital, Fudan University Shanghai, China.
authors.forename: Ru
authors.initials: R
authors.lastname: Lin
authors.affiliation: Key Laboratory of Female Reproductive Endocrine Related Diseases, Obstetrics and Gynecology Hospital, Fudan University Shanghai, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Yuan
authors.affiliation: Key Laboratory of Female Reproductive Endocrine Related Diseases, Obstetrics and Gynecology Hospital, Fudan University Shanghai, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Key Laboratory of Female Reproductive Endocrine Related Diseases, Obstetrics and Gynecology Hospital, Fudan University Shanghai, China.
authors.forename: Congjian
authors.initials: C
authors.lastname: Xu
authors.affiliation: Department of Obstetrics and Gynecology, Renji Hospital, Jiaotong University Shanghai, China.
authors.forename: Yifeng
authors.initials: Y
authors.lastname: He
authors.affiliation: Key Laboratory of Female Reproductive Endocrine Related Diseases, Obstetrics and Gynecology Hospital, Fudan University Shanghai, China.
authors.forename: Weiguo
authors.initials: W
authors.lastname: Hu
keywords: Cesarean scar pregnancy; combined laparoscopy and hysteroscopy; methotrexate; uterine artery embolization; uterine curettage