Clinical investigation of fertility after uterine artery embolization combined with dilation and curettage(D&C) or D&C alone for cesarean scar pregnancies

Objective

The aim of this study was to compare the reproductive outcomes of patients with cesarean scar pregnancies (CSP) following uterine artery embolization (UAE) and dilation and curettage (D&C) treatments, and to evaluate the impact of UAE on fertility.

Materials

and methods: A retrospective case-control study was conducted. Patients diagnosed with CSP between 2019 and 2021 were included in the study. Clinical data and fertility outcomes were collected and reviewed retrospectively. Patients were divided into two groups based on their treatment option: the UAE combined with D&C group and the D&C alone group.

Results

A total of 91 CSP patients were enrolled in the study. Of these, 49 were treated with D&C, while 42 received UAE combined with D&C. The average gestational age in the UAE group was significantly longer than that in the D&C group. The average diameter of the gestational mass was significantly larger in the UAE group than in the D&C group (42.2 ± 19.8 mm vs 23.8 ± 15.9 mm). The other clinical features were not significantly different between the two groups. The average menstrual recovery time was 1.0 ± 0.20 months (range: 1–2 months) in the D&C group, and 2.0 ± 2.85 months (range: 1–18 months) in the UAE combined with D&C group, with a significant difference between the two groups. The average menstrual blood volume (MBV) decreased in 79 % of patients in the UAE group, compared to 18 % in the D&C group, with a significant difference between the two groups. There was no significant difference between the two groups in terms of pregnancy rate and birth rate (75 % vs 78 %, 63 % vs 56 %).

Conclusion

UAE combined with D&C is an efficient and safe treatment for CSP. Our study showed that decreased MBV and longer menstrual recovery time in UAE combined with D&C group, but there are no statistical difference in fertility outcomes between the two groups, which suggests probably a reversible impact on the reproductive function.