Evaluation Effectiveness of Pre-Treatment Combined with Ultrasound-Guided Suction Curettage in Cesarean Scar Pregnancy: A Retrospective Cohort Study

Background: The objective of this study is to assess the effectiveness of ultrasound-guided suction curettage (UGSC) in conjunction with or without high-intensity focused ultrasound (HIFU) or uterine artery embolization (UAE) for the treatment of three distinct types of cesarean scar pregnancy (CSP).Methods: This was a retrospective study that included subjects diagnosed with CSP in a single tertiary referral centre from January 2015 to December 2020. UGSC associated with/without pretreatment was offered to CSP patients according to the location of pregnancy sac, the depth of implantation and the surrounding blood flowing. The data about baseline characteristics and outcome parameters were analyzed across the three groups.Results: The present study included 434 patients diagnosed with CSP. The majority were cured without severe complication except one case accepted blood transfusion. The baseline data from the three groups did not differ statistically. The UGSC group had the same successful rate of treating type I CSP with a shorter hospital stay (chi 2 = 51.771, p = 0.000) compared to the HIFU or UAE groups. Type II CSP presented marked less blood loss (Z = -2.464, p = 0.014) and higher decline ration of beta-human chorionic gonadotropin (beta-HCG) (Z = -4.728, p = 0.000) in HIFU group. Treatment success was high in patients with type III CSP in both the HIFU and UAE groups, but the rate of beta-HCG decline was higher in the HIFU group (Z = -2.255, p = 0.024).Conclusions: This study suggests that UGSC is an effective and safe option for patients with low-risk CSP. HIFU or UAE combined with UGSC has higher efficacy in high-risk CSP. And HIFU may be superior in reducing bleeding and increasing the rate of beta-HCG decline.