ĐẶC ĐIỂM HÌNH ẢNH CHỤP MẠCH SỐ HOÁ XOÁ NỀN VÀ KẾT QUẢ CỦA KĨ THUẬT NÚT MẠCH TRƯỚC ĐÌNH CHỈ THAI TẠI VỊ TRÍ SẸO MỔ CŨ

Abstract

Objective: Cesarean Scar Pregnancy (CSP) is a condition in which the gestational sac is implanted within the cesarean section scar of the uterus, a structurally weak site in the myometrium. CSP can result in massive hemorrhage, uterine rupture, and pose life-threatening risks to the patient as well as jeopardize future fertility. This study aimed to describe the digital subtraction angiography (DSA) imaging features and treatment outcomes of CSP termination in order to optimize therapeutic strategies. Methods: A retrospective descriptive study was conducted on 52 patients with CSP who underwent uterine artery embolization at the Center for Diagnostic Imaging and Nuclear Medicine, Vietduc University Hospital, followed by dilation and curettage at the National Hospital of Obstetrics and Gynecology. Pre- and post-embolization DSA findings, the rate of intrauterine balloon tamponade, and hospital stay were analyzed. Results: CSP vascularity on DSA was classified as follows: Grade I (23/52 patients, 44.2%), Grade II (19/52 patients, 36.6%), and Grade III (10/52 patients, 19.2%). Collateral blood supply was observed in 6/52 cases, including the superior vesical artery in 4 cases, bilateral ovarian arteries in 1 case, and the middle rectal artery in 1 case. In total, 21/52 patients required intrauterine balloon tamponade for hemostasis after dilation and curettage. No major complications occurred. The median hospital stay following pregnancy termination was 1 day (IQR: 1–2). Patients with Grade III vascularity on DSA had a significantly higher rate of intrauterine balloon tamponade and longer hospital stay compared with Grade I and II groups (p < 0.01). Conclusion: DSA-based vascular grading of CSP provides detailed information on lesion vascularity and facilitates the planning of effective hemostatic strategies following dilation and curettage.