Modified double balloon Foley catheter treatment for cesarean scar pregnancy at Hung Vuong Hospital in Vietnam
Abstract
Background: Cesarean scar pregnancy are unrelated forms of pathological pregnancies carrying significant diagnostic and treatment challenges, with a wide range of treatment effectiveness and complication rates ranging from 10% to 62%. At times, life-saving hysterectomy and uterine artery embolization are required to treat complications.
Study design: A retrospective study. Patients with diagnosed cesarean scar pregnancy between 6 and 8 weeks’ gestation were considered for the treatment. Insertion of the catheter and inflation of the upper balloon were done under transabdominal ultrasound guidance. The lower (pressure) balloon was inflated opposite the gestational sac under transvaginal ultrasound guidance. After an hour, the area of the sac was scanned. After 1 - 4 days, a follow-up appointment was scheduled for possible catheter removal. Serial ultrasound (US) and serum human chorionic gonadotropin were followed weekly or as needed.
Results: 50 live cesarean scar pregnancies were successfully treated from 2020 - 2022. Median gestational age at treatment was 6.0 ± 0.71 weeks (range, 6 - 8 weeks). Patients tolerated the double balloon treatment well, despiste reporting initial mild abdominal pressure during balloon. The balloons were in place for a median of 24 hours. Median time from treatment to the total drop of human chorionic gonadotropin was 6.9 ± 3.6 weeks . Successful with balloon inflated 84% (42/50 cases).
Conclusion: The modifier double balloon Foley catheter is a successful, minimally invasive and well-tolerated single treatment for cesarean scar pregnancy. This treatment method has 5 main advantages: it effectively stops embryonic cardiac activity, prevents bleeding complications, does not require any additional invasive therapies, familiar to obstetricians-gynecologists who use the same cervical ripening catheters for labor induction and very cheap. Its wider application, however, has to be validated on a larger patient population.
DOI: 10.59715/pntjmp.4.2.21
