title: Cesarean Scar Pregnancy: Comparing the Efficacy and Tolerability of Treatment with High-Intensity Focused Ultrasound and Uterine Artery Embolization.
abstract: The aim of this study was to investigate the clinical efficacy of high-intensity focused ultrasound (HIFU) for the treatment of a cesarean scar pregnancy compared with uterine artery embolization (UAE) and intra-arterial methotrexate infusion combined with uterine curettage. In this retrospective cohort study, 31 patients were treated with HIFU (HIFU group), and 45 patients were treated with UAE (UAE group). We compared the treatment and recovery of the patients, including follow-up. After UAE treatment, serum levels of the β subunit of human chorionic gonadotropin declined significantly on the first day, and the residual lesions disappeared in 3-17 wk. One patient underwent hysterectomy; intrauterine adhesions were found by hysteroscopic examination after 6 mo in 2 patients, whose menstrual function did not return to normal. The remainder of the 42 patients recovered normal menstrual functioning during the 3- to 18-wk follow-up. In the patients who underwent HIFU treatment, serum β-HCG levels did not decline rapidly; serum β-HCG levels increased in many patients and then declined to normal steadily within 2-12 wk. Lesions detached in 3-14 wk in all patients, and menstrual functioning was recovered in 3-9 wk without uterine curettage. Compared with the UAE group, the HIFU group had less pain and fewer complications; the patients in the HIFU group were not hospitalized or anesthetized and had lower costs. HIFU is an efficient, tolerable and non-invasive treatment.
authors.affiliation: Department of HIFU Treatment Room, First Affiliated Hospital of Nanchang University, Nanchang, China; Department of Ultrasound, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China.
authors.forename: Juhua
authors.initials: J
authors.lastname: Xiao
authors.affiliation: Department of Gynaecology and Obstetrics, First Affiliated Hospital of Nanchang University, Nanchang, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Shi
authors.affiliation: Department of HIFU Treatment Room, First Affiliated Hospital of Nanchang University, Nanchang, China.
authors.forename: Jinshui
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Department of Ultrasound, First Affiliated Hospital of Gannan Medical University, Ganzhou, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Ye
authors.affiliation: Department of HIFU Treatment Room, First Affiliated Hospital of Nanchang University, Nanchang, China.
authors.forename: Jianfang
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Department of Ultrasound, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Department of HIFU Treatment Room, First Affiliated Hospital of Nanchang University, Nanchang, China. Electronic address: wfwajwu@126.com.
authors.forename: Fang
authors.initials: F
authors.lastname: Wang
authors.affiliation: Department of General Surgery, Jiangxi Children's Hospital, Nanchang, China.
authors.forename: Shouhua
authors.initials: S
authors.lastname: Zhang
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage; D000328:Adult; D002585:Cesarean Section; D002921:Cicatrix; D005260:Female; D005500:Follow-Up Studies; D057086:High-Intensity Focused Ultrasound Ablation / Q000379:methods*; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055357:Uterine Artery Embolization / Q000379:methods*
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate
keywords: Cesarean scar pregnancy; High-intensity focused ultrasound; Non-invasive treatment; Uterine artery embolization