Combined laparoscopy and hysteroscopy vs. uterine curettage in the uterine artery embolization-based management of cesarean scar pregnancy: a cohort study.

AIM To evaluate the efficacy of combined laparoscopy and hysteroscopy compared with traditional uterine curettage in removing the ectopic conceptus and repairing the tissue defect following uterine artery embolization (UAE) management of cesarean scar pregnancy (CSP). DESIGN A prospective cohort study. SETTING Three large obstetrics and gynecology centers in Shanghai, China. SAMPLE CSP patients diagnosed between March 2009 and August 2010 who had received no prior treatments, were hemodynamically stable, and had no contraindications for UAE were enrolled. METHODS Patients were divided into two cohorts to undergo the intra-arterial methotrexate (MTX), UAE, and one of the following treatments: combined laparoscopy and hysteroscopy (research group, 25 cases) and uterine curettage (control group, 33 cases). MAIN OUTCOME MEASURES The conceptus removal rate, the severity of intra- and postoperative complications, surgical time, and duration of hospital stay. RESULTS The single-surgery conceptus removal rate reached 100% in the research group, which was significantly higher than the 82% (P=0.024) observed in the control group (with one hysterectomy). The average volume of intraoperative blood loss was 78.0 mL in the research group, which was much less than the 258.5 mL (P=0.004) in the control group. Moreover, the research group had significantly shorter hospital stays and β-hCG regression times, as well as lower rates of postoperative abdominal pain, uterine bleeding and menstruation abnormalities. CONCLUSIONS Combined laparoscopy and hysteroscopy is much safer and more effective than uterine curettage as a supplementary measure following UAE.