Clinical efficacy and safety between high-intensity focused ultrasound and uterine artery embolization for cesarean scar pregnancy: a systematic review and a meta-analysis

BACKGROUND It was reported that high-intensity focused ultrasound (HIFU) of cesarean scar pregnancy (CSP) can locally inactivate pregnancy tissue. Uterine artery embolization (UAE) can achieve good results for CSP too. To investigate the clinical efficacy and safety of HIFU and UAE in the treatment of cesarean scar pregnancy (CSP), we conducted this research. METHODS Multiple databases were used to search for relevant studies and articles related to HIFU, UAE, and CSP. The selected literature were retrospectively evaluated using Review Manager 5.2. In addition, forest plots, sensitivity analysis, and bias analysis were conducted for the included literature. RESULTS Finally, 8 related studies met the inclusion criteria. There were no significant differences in postoperative adverse reactions and hospitalization time between the HIFU group and the UAE group. However, the normalization time of serum beta human chorionic gonadotropin (B-HCG) in the HIFU group was higher than that in the UAE group [MD =1.16, 95% confidence interval (CI), 0.09, 2.22, P=0.03, I2=93%], and the hospitalization cost in the HIFU group was significantly lower than that in the UAE group (MD =-8.81, 95% CI, -12.64, -4.97, P<0.00001, I2=99%). DISCUSSION Our results show that HIFU and UAE have the same curative effect in the treatment of CSP, but HIFU has lower cost and fewer complications. These results supported that compared with UAE, HIFU is a better choice for CSP patients with long gestational age, large gestational sac diameter and high HCG level.