Efficacy and safety of high-intensity focused ultrasound combined with suction curettage for the treatment of caesarean scar pregnancy: a systematic review and single-arm meta-analysis

Figures & data

Figure 1. Flow chart of reports recruitment with inclusion and exclusion criteria.

Table 1. Characteristics of studies included in this meta-analysis.

Study	Grouping situation	No. Of patients	Age (mean ± SD, years)	Gestational age (days)	Largest diameter of the sac(mm)	No. of pregnancies after treatment	CS interval (mean ± SD, years)	No. of cesarean deliveries	Quality indicators	Type of uterine suction curettage
Fang 2020 [24]	NA	27	30.55 ± 4.01	51.08 ± 13.47	24.35 ± 10.22	NA	58.92 ± 30.96	1.37 ± 0.63	7	Simple uterine suction curettage
Hong 2017 [25]	NA	85	32.87 ± 4.64	50.58 ± 9.02	39.18 ± 21.61	NA	54.92 ± 35.73	NA	8	Hysteroscopy combined with uterine suction curettage
Huang 2014[26]	NA	10	28.70 ± 15.50	NA	NA	1	0.50–1.42	NA	5	Hysteroscopy combined with uterine suction curettage
Huo 2020 [27]	NA	46	30.61 ± 2.54	NA	NA	NA	4.67 ± 1.38	3.70 ± 0.50	NA	Simple uterine suction curettage
Liu 2020 [28]	NA	103	32.40 ± 4.65	47.67 ± 6.79	24.35 ± 10.22	NA	NA	1.50 ± 0.30	8	Hysteroscopy combined with uterine suction curettage
Liu 2022 [9]	Type I CSP	101	31.56 ± 4.05	55.75 ± 6.13	35.17 ± 7.05	NA	NA	NA	NA	Ultrasound-guided uterine suction curettage
Liu 2022 [9]	Type II CSP	52	33.61 ± 4.46	57.85 ± 5.19	36.12 ± 8.60	NA	NA	NA	NA	Ultrasound-guided uterine suction curettage
Mu 2022 [29]	NA	41	33.60 ± 7.80	50.31 ± 8.27	3.49 ± 0.94	NA	38.00(21.00, 84.00)	1.60 ± 0.70	NA	Ultrasound-guided uterine suction curettage
Peng 2022 [30]	Type I CSP	43	35.60 ± 3.80	46.00 (42.00, 55.00)	19.00(12.00, 23.20)	NA	60.00(36.00, 84.00)	2.00 ± 0.60	NA	Ultrasound-guided uterine suction curettage
Peng 2022 [30]	Type II CSP	89	34.00 ± 4.00	46.00 (43.00, 53.00)	20.30 (17.00, 27.00)	NA	60.00 (35.00, 84.00)	1.24 ± 0.40	NA	Ultrasound-guided uterine suction curettage
Peng 2022 [30]	Type III CSP	21	35.00 ± 4.10	51.00 (48.00, 56.00)	26.70 (20.50, 31.20)	18	84.00 (30.00, 114.00)	1.00 ± 0.70	NA	Ultrasound-guided uterine suction curettage
Wang 2022 [31]	NA	100	32.53 ± 4.88	48.31 ± 7.10	26.00 ± 9.91	78	NA	1.00(1.00–3.00)	8	Ultrasound-guided uterine suction curettage
Wang 2023[15]	NA	154	31.39 ± 5.02	48.00(42.00–55.00)	27.23 ± 11.10	NA	4.00(2.00–6.00)	NA	8	Ultrasound-guided uterine suction curettage
Xiao 2014 [14]	NA	16	30.70 ± 3.40	48.30 ± 8.70	24.80 ± 5.90	NA	40.90 ± 39.10	1.10 ± 0.30	NA	Simple uterine suction curettage
Xiao 2016 [32]	NA	31	30.84 ± 4.05	52.03 ± 8.18	25.03 ± 8.75	NA	4.34 ± 3.19	1.29 ± 0.59	9	Ultrasound-guided uterine suction curettage
Yin 2022 [21]	‘C-shape’ sonication	44	31.50 (30.25, 35.00)	31.50 (30.25, 35.00)	26.86 ± 10.13	NA	5.50 (3.33,8.75)	1.10 ± 0.30	7	Ultrasound-guided uterine suction curettage
Yin 2022 [21]	‘I-shape’ sonication	47	33.00 (30.00, 37.00)	33.00 (30.00, 37.00)	23.57 ± 10.03	8	5.00 (4.00,9.00)	1.00 ± 0.30	NA	Ultrasound-guided uterine suction curettage
Yuan 2021 [33]	NA	52	31.33 ± 4.74	48.67 ± 6.87	33.04 ± 1.45	NA	NA	1.80 ± 0.40	NA	Ultrasound-guided uterine suction curettage
Zhang 2019 [20]	NA	28	31.18 ± 4.88	44.00 (41.00, 48.00)	28.69 ± 9.51	12	4.79 ± 3.93	NA	NA	Ultrasound-guided uterine suction curettage
Zhang 2021 [34]	NA	9	NA	NA	NA	NA	NA	NA	5	Simple uterine suction curettage
Zhu 2015 [35]	NA	53	31.80 ± 4.80	47.70 ± 5.00	37.00 (13.00–60.00)	NA	48.00 (4.00–218.00)	1.40 ± 0.50	9	Hysteroscopy combined with uterine suction curettage
Zhu 2016 [36]	NA	76	32.50 ± 5.00	55.20 ± 16.20	33.10 ± 15.70	NA	60.00 ± 59.00	1.30 ± 0.50	7	Hysteroscopy combined with uterine suction curettage

Abbreviations: SD, standard deviation; CS, caesarean delivery; CSP, caesarean scar pregnancy.

Table 2. Quality assessment of case series.

Description	Selection	Ascertainment		Causality				Reporting
	1. Does the patient(s) represent(s) the whole experience of the investigator (centre) or is the selection method unclear to the extent that other patients with similar presentation may not have been reported?	2. Was the exposure adequately ascertained?	3. Was the outcome adequately ascertained?	4. Were other alternative causes that may explain the observation ruled out?	5. Was there a challenge/ rechallenge phenomenon?	6. Was there a dose– response effect?	7. Was follow-up long enough for outcomes to occur?	8. Is the case(s) described with sufficient details to allow other investigators to replicate the research or to a llow practitioners make inferences related to their own practice?
Huo 2020	U	Y	Y	Y	Y	N	Y	Y
Liu 2022	U	Y	Y	Y	Y	N	Y	Y
Mu 2022	U	Y	Y	Y	Y	N	Y	Y
Peng 2022	U	Y	Y	Y	Y	N	Y	Y
Xiao 2014	U	Y	Y	Y	Y	N	Y	Y
Yuan 2021	U	Y	Y	Y	Y	N	Y	Y
Zhang 2019	U	Y	Y	Y	Y	N	Y	Y

Notes: Y: yes; U: unclear; N: no.

Figure 2. Forest plots showing the perioperative factors of patients with CSP treated with HIFU combined with suction curettage. (A) length of hospital stay; (B) intraoperative blood loss; (C) rates of adverse events. Abbreviations: CSP: caesarean scar pregnancy; HIFU: high-intensity focused ultrasound.

Figure 3. Forest plots showing the postoperative follow-up of patients with CSP treated with HIFU combined with suction curettage. (A) time to normalization of serum β-human chorionic gonadotropin levels; (B) time to normal menstrual recovery. Abbreviations: CSP: caesarean scar pregnancy; HIFU: high-intensity focused ultrasound.

Figure 4. (A) Forest plots showing the success rate of patients with CSP treated with HIFU combined with suction curettage. (B) Forest plots showing the subsequent pregnancy outcomes of patients with CSP treated with HIFU combined with suction curettage. Abbreviations: CSP: caesarean scar pregnancy; HIFU: high-intensity focused ultrasound.

Figure 5. (A) Forest plot showing the average hospital stay of patients with CSP treated with HIFU combined with different types of suction curettage. (B) Forest plot showing the average time for menstrual recovery of patients with CSP treated with HIFU combined with different types of suction curettage. (C) Forest plot showing the average time for serum β-HCG normalization of patients with CSP treated with HIFU combined with different types of suction curettage. Abbreviations: CSP, caesarean scar pregnancy; HIFU: high-intensity focused ultrasound; HCG: human chorionic gonadotropin.

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Data availability statement

The data used to support the findings of this study are available from the corresponding author upon request.