A Retrospective Analysis of the Treatment of Cesarean Scar Pregnancy by High-Intensity Focused Ultrasound, Uterine Artery Embolization and Surgery

Objective: This study aims to retrospectively analyze the clinical curative effects of surgery, uterine artery embolization (UAE), and high-intensity focused ultrasound (HIFU) in order to provide the theory and evidences for selecting the optimal treatment for cesarean scar pregnancy (CSP). Methods: Women with CSP were treated with surgery (laparoscopic, hysteroscopy, and hysteroscopy–laparoscopic surgery), UAE combined with curettage, and HIFU combined with curettage. The general conditions and therapeutic effects, including vital signs during the operation, discomfort of discharge, cure rate, total blood loss, decline in the rate of hCG, and hospital stay, were compared and analyzed. Results: For the 154 CSP patients, the cure rate of surgery (n = 95) was 97.89%, the cure rate of UAE (n = 32) was 43.74%, and the cure rate of HIFU (n = 27) was 70.37%. The difference was statistically significant (P < 0.05). Furthermore, the hCG level of surgical patients quickly declined, whereas HIFU slowly declined. The difference between the decline rate of hCG and mean hospitalization time was statistically significant (P < 0.05). UAE was good for CSP with gestational age <60 days and diameter of gestational sac <40 mm. Furthermore, HIFU was well for CSP patients with a gestational age of <55 days and a gestational sac diameter of <30 mm. Surgery was suitable for any type of these cases. Conclusion: CSP patients with short gestational age and small gestational sac can be treated with surgery, UAE, and HIFU, and achieve safe and effective therapeutic effects. Surgery is also a good choice for CSP for patients with a long gestational age, a large gestational sac diameter, high levels of hCG, or an ample blood supply.