The management of caesarean scar pregnancy with or without a combination
of methods prior to hysteroscopy: ovarian reserve trends and patient
Study Objective: This study compared the efficacy and safety of a
combination of uterine artery embolization or methotrexate before
hysteroscopy in the treatment of cesarean scar pregnancy. Methods: We
divided 276 cesarean scar pregnancy patients into three groups. Group A
underwent direct hysteroscopy; Group B received uterine artery
embolization plus hysteroscopy; Group C received the systemic
administration of methotrexate prior to hysteroscopy. Results: The
patients in Group A lost significantly more blood than those in Groups B
(P ＜ 0.05). There were no significant differences between the three
groups with regards to massive hemorrhage and transfusion (P ＞ 0.05).
None of the patients required hysterectomy. Group A was also associated
with a significantly shorter period of hospitalization, reduced medical
costs, and fewer adverse events than either Group B or C (P ＜ 0.05).
Moreover, among women of advanced age (≥35y), the levels of serum
anti-Mullerian hormone in Group B were significantly lower than those of
the baseline group (P＜0.05), which were significantly lower than those
in Group A after surgery (4.22 ± 2.35 vs 2.78± 1.89 ng/ml, P ＜ 0.05).
Conclusion: Direct hysteroscopy is a reliable treatment option for most
early type I cesarean scar pregnancy patients with a gestational sac. A
combination of methotrexate and uterine artery embolization before
hysteroscopy in these patients has limited remedial effects. uterine
artery embolization may reduce ovarian reserve in patients aged ≥35y.