Available online 26 November 2022

High intensity focused ultrasound (HIFU) followed by curettage or uterine artery embolization (UAE) followed by curettage are relatively effective methods for cesarean scar pregnancy(CSP), which can provide a high success rate and re-pregnancy while reducing blood loss and adverse events. Therefore, we conducted this meta-analysis to evaluate the efficacy, safety, and pregnancy outcome of HIFU groups versus UAE groups with CSP.

The PubMed, EMBASE, Cochrane, China National Knowledge Infrastructure, and Wanfang databases were systematically searched to find studies about comparing the therapeutic effects of HIFU groups versus UAE groups.

Our primary endpoints were blood loss, adverse events, success rate, and re-pregnancy. We have implemented random effects models or fixed effects models to evaluate the pooled data.

Thirty-four eligible items were included in studies. The blood loss was significantly reduced [standardized mean difference (SMD) = -1.45, 95%CI, 2.21 to -0.68; p< 0.001)]. The adverse events occurred significantly less than UAE groups [odds ratio (OR) =0.36, 95%CI, 0.23 to 0.57; p<0.001). The success rate of HIFU groups was higher than UAE groups (OR =1.56, 95%CI, 1.05 to 2.32; p = 0.03), There were more pregnancies in HIFU groups than in the UAE groups (OR=1.64, 95%CI, 1.28 to 2.11; p <0.001).

In the CSP, the effect of HIFU groups is better than UAE groups: little blood loss, high success rate, few adverse events, and favorable fertility protection. Thus, it is a promising therapeutic method for patients.

high-intensity focused ultrasound

uterine artery embolization

non-invasive

re-pregnancy

© 2022 Published by Elsevier Inc. on behalf of AAGL.