The effect of ultrasound-guided high-intensity focused ultrasound treatment for cesarean scar pregnancy on ovarian reserve

Figures & data

Figure 1. Flow diagram of enrolled patients. CSP, cesarean scar pregnancy; HIFU, high-intensity focused ultrasound; UAE, uterine artery embolization; MTX, Methotrexate; AMH, anti-Müllerian hormone.

Figure 2. Contrast-enhanced ultrasound images before and after HIFU ablation (sagittal). (A) The gestational sac (blue arrow) and blood flow (red arrow) were presented on transabdominal color Doppler contrast-enhanced ultrasound before HIFU ablation. (B) Contrast-enhanced ultrasound showed the gestational sac was deformed (blue arrow) and blood perfusion was significantly reduced (red arrow) after HIFU ablation.

Table 1. Demographic characteristics of the study population.

Characteristic	Value
Number of patients	32
Age (years)	32.3 ± 4.9 (range, 25–44 years)
Number of pregnancies	4 (range, 2–10)
Previous cesarean delivery, n
1	20
2	11
3	1
Previous CSP, n
0	31
1	1
Interval time from the last CS (months)	51 (range, 35–73 months)
Gestational age (days)	47.2 ± 6.2 (range, 37–60 days)
Serum β-hCG (IU/L)	56,250.0 (range, 4276–181,180 IU/L)
Largest diameter of the sac/mass (mm)	26.8 ± 10.0 (range, 8–47 mm)
Fetal heart activity detected, n	16 (50%)
Patients with myometrial  thickness >3 mm, n	9 (28.1%)
Patients with myometrial  thickness ≤3 mm, n	23 (71.9%)

CSP: cesarean scar pregnancy; CS: cesarean section; β-hCG: β-human chorionic gonadotropin.

Table 2. Treatment results of the study population (n = 32).

Variables	Value
HIFU
Treatment time (minutes)	41.2 ± 9.2
Ablation time (seconds)	456.2 ± 162.9
Treatment energy (Joules)	180,725.0 ± 64,877.5
Suction curettage
Hysteroscopic guidance, n	20
Ultrasound-guided, n	10
No suction curettage, n	2
Median time from HIFU to curettage (days)	2 (range, 1–7 days)
Median volume of intraoperative blood loss (ml)	20 (range, 5–400 ml)
Follow-up
Median hospitalization time (days)	8 (range, 5–18 days)
Time for β-hCG to return to normal (days)	35.5 (range, 20–83 days)
Time of menstruation recovery (days)	39 (range, 22–72 days)
AMH levels before HIFU (ng/ml)	1.87 ± 1.19
AMH levels 3 months after HIFU (ng/ml)	1.90 ± 1.17

Figure 3. AMH levels after HIFU treatment for CSP. AMH levels (ng/ml) before and at 3 months after HIFU were not significantly different by paired t-test (P-value = .680).