L.E. TEREGULOVA^{1, 3, A}.Y. TEREGULOV^{2, 3, M}.R. KHAYRUTDINOVA³, D.R. GAYAZOV^{2, 3}, N.Yu. SAVUSHKINA³

¹ Kazan State Medical University, 49 Butlerov Str., Kazan, Russian Federation, 420012

² KSMA – Branch Campus of the FSBEI FPE RMACPE MOH Russia , 36 Butlerov Str., Kazan, Russian Federation, 420012

³ Republican Clinical Medical Hospital of the Ministry of Health of the Republic of Tatarstan, 138 Orenburgskiy highway, Kazan, Russian Federation, 420064

Teregulova L.E. ― Cand. Med. Sc., Associate Professor, Head of the Department of Ultrasound Diagnostics, tel. + 7-917-269-58-41, e-mail: tereg@mail.ru

Teregulov A.Yu. ― Cand. Med. Sc., Head of the Angiography Department, tel. + 7-917-269-58-40, e-mail: tereg@yandex.ru

Khayrutdinova M.R. ― Doctor of the Department of Gynecology, tel. +7 951-896-25-97,

E-mail: marina.gaifullina@gmai.com

Gayazov D.R. ― surgeon of the Unit of X-ray diagnostic methods of treatment and diagnostics, tel. + 7-953-490-33-24, e-mail: minardinka@rambler.ru

Savushkina N.Yu. ― Cand. Med. Sc., Doctor of the Department of ultrasound investigation, tel. +7 903-340-74-82S e-mail Savushkina47@bk.ru

To study the possibility of minimally invasive organ-preserving treatment of cicatricial pregnancy, depending on the results of ultrasound investigation, 32 patients with a diagnosis of «cicatricial pregnancy» aged 25 to 45 years were examined. In the anamnesis, all pregnant women have at least 1 cesarean section. All pregnant women underwent transvaginal ultrasound investigation and a blood test for hCG. Depending on the ultrasound data and the level of hCG, the patients underwent different types of minimally invasive organ-preserving treatment: vacuuming of the fetal egg or highly selective uterine artery embolization (UAE) with or without the administration of methotrexate endoarterially, if necessary after metastasis, methotrexate was locally administered to the fetal egg transvaginally under control of ultrasound investigation. It is demonstrated that there are clear ultrasonic criteria for chorionic ingrowth in cicatricial pregnancy (absence of rumen visualization, abnormal thickening of the chorion with intensive blood flow by arterio-venous type, bulging of the embryo to the outside). The use of ultrasonic criteria for the growth of chorion into the scar allows a differentiated, minimally invasive organ-preserving treatment.

Key words: cicatricial pregnancy, ultrasound investigation, uterine artery embolization, methotrexate, human chorionic gonadotropin (hCG).

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