Short- and long-term efficacy evaluation of high-intensity focused ultrasound ablation and uterine artery embolization in the treatment of cesarean scar pregnancy (CSP) I and II: a retrospective cohort study

Objectives To retrospectively analyze and compare the safety, effectiveness, and long-term pregnancy outcomes of high-intensity focused ultrasound (HIFU) versus uterine artery embolization (UAE), both followed by ultrasound-guided dilatation and curettage (USg-D&C), in treating cesarean scar pregnancy (CSP) type I and II, offering clinical insights. Design A retrospective cohort study (Fujian Maternal and Child Health Hospital). Setting University hospital. Patients From June 2021 to December 2024, a total of 84 patients were included, all diagnosed with CSP I or II and treated by high-intensity focused ultrasound (HIFU) or uterine artery embolization (UAE), followed by USg-D&C. Interventions None. Measurements and main results Follow-up of the reproductive outcomes ended in December 2024, 40 patients received HIFU ablation and 44 patients received UAE both followed by USg-D&C, involved in the study. Results Baseline characteristics were comparable between the two groups (all p > 0.05). The HIFU group had a significantly shorter hospital stay than the UAE group (4.7 ± 1.8 days vs. 5.9 ± 2.7 days, p = 0.042) and a lower incidence of reduced menstrual flow (25.0% vs. 47.7%, p = 0.002). No significant differences were found in intraoperative blood loss, operation time, β-hCG normalization time, or menstrual recovery time (all p > 0.05). The intrauterine pregnancy rate was 66.7% in the HIFU group and 47.4% in the UAE group ( p = 0.259), but the HIFU group had a significantly shorter time from treatment to intrauterine pregnancy (18.1 ± 2.2 months vs. 22.7 ± 1.7 months, p = 0.019) and time from conception attempt to pregnancy (9.5 ± 1.3 months vs. 16.6 ± 2.1 months, p = 0.013). Conclusion Compared with UAE, HIFU in the treatment of CSP type I and type II results in shorter hospital stays for patients, milder effects on menstrual volume, and shorter intervals to pregnancy and conception preparation durations. However, no statistically significant difference was noted in the long-term intrauterine pregnancy rate between the two groups. Future research should prioritize high-quality randomized controlled trials with prospective design, large sample sizes, and multi-center settings.