title: High-intensity focused ultrasound combined with suction curettage for the treatment of cesarean scar pregnancy.
abstract: The aim of this study was to retrospectively evaluate the safety and feasibility of high-intensity focused ultrasound (HIFU) treatment combined with suction curettage under hysteroscopic guidance for cesarean scar pregnancy (CSP).Fifty-three patients with definite CSP were treated with HIFU followed by suction curettage under hysteroscopic guidance. All the patients received 1 session of HIFU ablation under conscious sedation. Suction curettage under hysteroscopic guidance was performed at an average of 2.9 (range: 1-5) days after HIFU ablation. Blood flow of pregnancy tissue before and after HIFU, intraoperative blood loss in suction curettage and hysteroscopy procedure, time for β-human chorionic gonadotropin (β-hCG) to return to normal level, and time for normal menstruation recovery were recorded.Immediately after HIFU treatment, color Doppler ultrasound showed that the fetal cardiac activity disappeared and the blood flow in the pregnancy tissue significantly decreased. All the patients underwent suction curettage under hysteroscopic guidance after the treatment of HIFU, the median volume of blood loss in the procedure was 20 mL (range: 10-400 mL). The average time for menstruation recovery was 35.1 ± 8.1 (range: 19-60) days. The average time needed for serum β-hCG to return to normal levels was 27.5 ± 6.4 (range: 12-40) days. The average hospital stay was 7.8 ± 1.5 (range: 5-11) days.Based on our results, it appears that HIFU combined with suction curettage under hysteroscopic guidance is safe and effective in treating patients with CSP at gestational ages <8 weeks.
authors.affiliation: From the Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha, Hunan Province (XZ, XD, YW, SX, MX); and State Key Laboratory of Ultrasound Engineering in Medicine, Chongqing Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China (JH, LZ).
authors.forename: Xiaogang
authors.initials: X
authors.lastname: Zhu
authors.forename: Xinliang
authors.initials: X
authors.lastname: Deng
authors.forename: Yajun
authors.initials: Y
authors.lastname: Wan
authors.forename: Songshu
authors.initials: S
authors.lastname: Xiao
authors.forename: Jiping
authors.initials: J
authors.lastname: Huang
authors.forename: Lian
authors.initials: L
authors.lastname: Zhang
authors.forename: Min
authors.initials: M
authors.lastname: Xue
mesh_terms: D000328:Adult; D002585:Cesarean Section; D002921:Cicatrix; D003131:Combined Modality Therapy; D005260:Female; D057086:High-Intensity Focused Ultrasound Ablation; D006801:Humans; D015907:Hysteroscopy; D011183:Postoperative Complications / Q000601:surgery*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014619:Vacuum Curettage