Transcatheter Arterial Embolization (TAE) of Uterine Artery with Gelatin Sponge for Cesarean Scar Pregnancy: A Current State of the Art Review

TL;DR

This review examines the use of gelatin sponge embolization for treating cesarean scar pregnancy, highlighting its high success rate and potential to preserve fertility.

Contribution

The paper provides a comprehensive review of gelatin sponge embolization techniques and outcomes for cesarean scar pregnancy.

Findings

Technical success rate of UAE with GS was ~99.8% across 50 studies.

Clinical success was ~94.8%, with high rates of hemostasis and fertility preservation.

Severe complications were rare (~2–4%), and menstrual recovery occurred within 1–2 months.

Abstract

Cesarean scar pregnancy (CSP) carries a high risk of severe hemorrhage and potential loss of fertility. This narrative review summarizes current evidence on uterine artery embolization (UAE) using absorbable gelatin sponge (GS), focusing on GS preparation, procedural approaches, and reported outcomes. PubMed/MEDLINE, Scopus, and Google Scholar were searched from January 2015 to 31 December 2024 for peer-reviewed studies reporting UAE with GS for CSP (GS alone or combined with intra-arterial methotrexate and/or adjunct particles). Fifty studies (N = 3139) were included. Technical success was 3133/3139 (~99.8%) and clinical success was 2975/3139 (~94.8%), with most cohorts reporting high clinical control. Severe complications were infrequently reported (typically ~2–4% in most series). Menstrual function, when assessed, generally recovered within ~1–2 months. Subsequent pregnancy outcomes were inconsistently reported and follow-up durations were heterogeneous, predominantly in retrospective designs. Overall, UAE with GS appears effective for hemostasis in CSP and may reduce escalation to hysterectomy in appropriately selected patients. Standardized reporting of GS preparation and outcomes, as well as prospective multicenter registries/studies, are needed to refine best practices.

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