Uterine Artery Embolization Versus Methotrexate for Cesarean Scar Pregnancy in a Chinese Population: A Meta-analysis

This systematic review and meta-analysis was performed to compare the efficacy and safety of uterine artery embolization (UAE) followed by curettage and methotrexate (MTX) plus curettage in the treatment of cesarean scar pregnancy (CSP) in China. Studies published in PubMed, Embase, Web of Science, SinoMed (Chinese BioMedical Literature Service System), and China National Knowledge Information were systematically searched. The main outcome measures included the time for serum β-human chorionic gonadotropin (β-hCG) normalization, the duration of hospital stay, blood losses, and adverse events. Results were expressed as the weighted mean difference (WMD) or risk ratio with 95% confidence intervals (CIs). Results showed that 11 studies involving a total of 725 patients were included in this meta-analysis. Compared with MTX plus curettage, UAE followed by curettage had 16.76 days less time for β-hCG normalization (WMD = -16.76 days; 95% CI, -24.60 to -8.92; p < .001), and 15.05 days less of hospital stay (WMD = -15.05 days; 95% CI, -25.42 to -4.67; p = .004). CSP patients who underwent UAE had 343.24 mL less blood loss compared with those treated with MTX plus curettage (WMD = -343.24 mL; 95% CI, -432.95 to -253.54; p < .001). Moreover, UAE was associated with a lower incidence of adverse events than those treated with MTX plus curettage (relative risk = 0.46; 95% CI, 0.26-0.81; p = .008). In conclusion, UAE combined with curettage significantly shortened the time for β-hCG normalization and hospital stay and reduced blood losses and adverse events compared with the administration of MTX plus curettage. For patients with CSP, UAE followed by curettage appears to be more advantageous and may be a priority option. Further well-conducted, large-scale trials are needed to validate these findings.