Clinical efficacy of curettage in treating cesarean scar pregnancy:a randomized controlled trial

To compare the safety and efficacy of curettage and their combination with uterine artery embolization (UAE) in the treatment of cesarean scar pregnancy (CSP) patients with a low score (≤4) in the ultrasound quantification scoring system.

Based on our inclusion and exclusion criteria of this randomized controlled study, the women with CSP who had an ultrasonic quantitative score ≤4 and were treated in our department from May 2020 to August 2023 were enrolled, and then randomly divided into a curettage group (n=48) and a UAE combination group (n=47) in a ratio of 1∶1. General information, intraoperative conditions, and use of rescue measures within 3 months after operation were collected in the 2 groups of patients. All the patients were followed up until October 2024 to observe the pregnancy outcomes and determine the impact on the menstrual volume after the resumption of normal menstruation.

The patients from the both groups completed the follow-up. Except for the maximum gestational sac diameter, there were no significant differences in other baseline data between the 2 groups, and the curettage group had notably more patients having a gestational sac diameter ≤25 mm than the combination group [37 (77.1%) vs 27 (57.4%), P<0.05]. No statistical differences were observed between the 2 groups in the intraoperative bleeding volume and use of rescue measures within 3 months after surgery. The combination group had obviously more patients with reduced menstrual volume after the resumption of normal menstruation than the dilation and curettage group [30 (63.8%) vs 13 (27.1%), P<0.001]. There were no statistically differences in pregnancy outcomes and the number of days to resume menstruation between the 2 groups.

For CSP patients with a score of ≤4 in the ultrasound quantification scoring system, curettage show no significant difference in therapeutic effectiveness, and even have better efficacy and safety when compared with curettage combined with UAE.