A comparison of high-intensity focused ultrasound and uterine artery embolisation for the management of caesarean scar pregnancy

Figures & data

Figure 1. Gestational sac implanted in the previous caesarean scar with empty uterus cavity and cervical canal; no myometrium was visible between the bladder and the sac.

Figure 2. Gestational sac implanted in the previous caesarean scar with empty uterus cavity and cervical canal (sagittal view of the MRI).

Figure 3. The pregnancy tissue located in the previous caesarean scar.

Figure 4. The pregnancy tissues were removed from the previous caesarean scar.

Table 1. Demographic characteristics of the patients with CSP.

Variables	HIFU group (n = 76)	UAE group (n = 46)	p Value
Age (years)	32.5 ± 5.0 (22–46)	31.4 ± 5.1 (23–42)	0.26
Gestational age (days)	55.2 ± 16.2 (37–91)	60.6 ± 16.4 (38–90)	0.08
Largest diameter of the sac/mass (mm)	33.1 ± 15.7 (12–100)	39.11 ± 18.19 (10–96)	0.06
Serum β-hCG* (mIU/mL)	30167 (117.3–143932)	29021 (31.7–205936)	0.21
Gravidity	3.9 ± 1.6 (1–8)	3.9 ± 1.6 (1–7)	0.90
Parity	1.4 ± 0.6 (1–3)	1.4 ± 0.5 (1–2)	0.84
No. of caesarean deliveries	1.3 ± 0.5 (1–3)	1.2 ± 0.5 (1–3)	0.17
Interval from the last caesarean section* (month)	60 (4–240)	48 (8–192)	0.37

β-hCG, β-human chorionic gonadotropin; CSP, caesarean scar pregnancy; HIFU, high-intensity focused ultrasound; UAE, uterine artery embolisation.

*The data are presented as median. The rank sum test was used for the analysis of these data.

Figure 5. The blood flow of pregnancy tissue examined by transabdominal colour Doppler scanning contrast medium revealed perfusion in the pregnancy tissue before HIFU ablation.

Figure 6. Contrast enhanced ultrasound showed no perfusion in the pregnancy tissue immediately after the HIFU treatment.

Table 2. Comparison of clinical outcomes between the two groups.

Variables	HIFU group (n = 76)	UAE group (n = 46)	p Value
Depth of the uterus (cm)	9.9 ± 1.4 (7–14)	10.3 ± 1.5 (8.5–15)	0.20
Intraoperative blood loss (mL)	90.6 ± 158.7 (10–800)	64.4 ± 103.7 (10–520)	0.32
Duration of vaginal bleeding (days)	15.5 ± 9.8 (1–40)	11.7 ± 10.0 (2–60)	0.01
Time for β-hCG reduction to an normal level (days)	27.6 ± 8.4 (7–48)	27.8 ± 7.7 (7–42)	0.91
Normal menstrual recovery (days)	34.9 ± 10.6 (10–60)	31.7 ± 10.8 (11–70)	0.11
Hospital stay (days)	7.8 ± 1.7 (5–15)	7.9 ± 3.0 (4–21)	0.78

β-hCG, β-human chorionic gonadotropin HIFU, high-intensity focused ultrasound; UAE, uterine artery embolisation.

Table 3. Comparison of the adverse effects between the groups.

Variables	HIFU group (n = 76)	UAE group (n = 46)	p Value
Pain*	2.9 ± 1.0 (1–8)	4.4 ± 1.6 (2–8)	0.00
Fever**	0 (0%)	1 (2.2%)	0.38
Acute pelvic inflammation**	0 (0%)	1 (2.2%)	0.38
Uterus perforation**	1 (1.3%)	0 (0%)	1.00
Subcutaneous induration**	1 (1.3%)	0 (0%)	1.00
Excessive vaginal bleeding**	4 (5.2%)	1 (2.2%)	0.65
Hip pain**	0 (0%)	1 (2.2%)	0.38
Lower limb pain or numbness**	0 (0%)	6 (13.0%)	0.00
Readmitted patient	8 (10.5%)	6 (13.0%)	0.67

HIFU, high-intensity focused ultrasound; UAE, uterine artery embolisation.

*t-test was used for the analysis of these data.

**Pearson’s chi-square test was used for the analysis of these data.