Application Value of Ligating the Inferior Uterine Artery Branches Via the Vagi-nal Route at the Cesarean Scar Site for the Treatment of Pregnancy / 实用妇产科杂志

ABSTRACT

Objective:To assess the feasibility of transvaginal ligation of inferior uterine artery branches as a preoperative intervention for Type Ⅱ,Type Ⅲ,and mass cesarean scar pregnancy(CSP)at the cesarean scar site.Methods:A retrospective analysis was conducted on 39 patients with Type Ⅱ,Type Ⅲ,and mass CSP treated at the Maternal and Child Health Hospital of Hubei Provincial from January 2021 to December 2022.Patients were categorized into two groups based on different pretreatment,the ligature group(n =20)underwent transvaginal uterine artery branch ligation,while the embolization group(n =19)underwent uterine artery embolization,both groups underwent laparoscopic pregnancy tissue removal and cesarean scar excision post-pretreatment.General data,intraoperative and postoperative clinical parameters,as well as follow-up data,were analyzed and compared between the two groups.Results:Compared with the embolization group,age,menopause time,number of preg-nancies,CSP type,myometrium thickness at the site of scar pregnancy,gestational sac size,preoperative anti-Mil-lerian hormone(AMH),blood flow resistance index(RI)at the scar site,preoperative white blood cell count,preop-erative C-reactive protein(CRP)and hemoglobin(Hb),postoperative CRP,preoperative white blood cell count,postoperative Hb,human chorionic gonadotropin(hCG)decreased ratio,spontaneous ventilation time,AMH and endometrial thickness at 1 month after surgery,there was no significant difference in the time of hCG return to normal after surgery(P>0.05).The intraoperative blood loss in the ligation group was higher than that in the em-bolization group,and the length of hospital stay and hospitalization cost were lower than those in the embolization group,and the difference was statistically significant(P<0.05).The postoperative complications(abdominal pain,changes in menstrual flow,intrauterine adhesions,and impaired ovarian function)were less in the ligation group(0)than in the embolization group(21.05%),and the difference was statistically significant(P<0.05).Conclu-sions:Transvaginal uterine artery branch ligation for Type Ⅱ,Type Ⅲ,and mass CSP pretreatment,in compari-son to uterine artery embolization,demonstrates safety,effectiveness,ease of operation,cost-effectiveness,and reduced postoperative complications.This approach proves to be a viable option for both emergency and non-e-mergency cases of Type Ⅱ,Type Ⅲ,and mass CSP.