Is High-intensity Focused Ultrasound Superior to Uterine Artery Embolization in Cesarean Scar Pregnancy and Subsequent Pregnancy Outcomes? A Meta-analysis of the Chinese Population

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 repregnancy while reducing blood loss and adverse events. Therefore, we conducted this meta-analysis to evaluate the efficacy, safety, and pregnancy outcomes 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 that compared the therapeutic effects of HIFU groups versus UAE groups.Our primary end points were blood loss, adverse events, success rate, and repregnancy. We 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 in HIFU groups compared with UAE groups (standardized mean difference = -1.45, 95% confidence interval [CI], 2.21 to -0.68; p <.001). Significantly fewer adverse events occurred in the HIFU groups than in UAE groups (odds ratio [OR] = 0.36, 95% CI, 0.23-0.57; p <.001). The success rate of HIFU groups was higher than that of UAE groups (OR = 1.56, 95% CI, 1.05-2.32; p = .03). There were more pregnancies in HIFU groups than in UAE groups (OR = 1.64, 95% CI, 1.28-2.11; p <.001).In the CSP, the effect of HIFU groups was better than that of UAE groups: less blood loss, high success rate, fewer adverse events, and favorable fertility protection. Thus, it is a promising therapeutic method for patients.