Comparison of the efficacy and safety of intra-aortic balloon occlusion and uterine artery embolization in types IIb–III cesarean scar pregnancy: a retrospective study

Objective Managing cesarean scar pregnancy (CSP) is clinically challenging because of the substantial risk of hemorrhage, which necessitates appropriate preoperative strategies. Uterine artery embolization (UAE) is widely used to reduce perioperative bleeding, whereas intra-aortic balloon occlusion (IABO) offers temporary vascular control without permanent embolization. This retrospective cohort study compared perioperative, economic, menstrual, and subsequent reproductive outcomes between IABO and UAE in patients with types IIb–III CSP. Methods This single-center retrospective cohort study included 73 patients with types IIb–III CSP admitted to Jiangxi Provincial Maternal and Child Health Hospital between June 2020 and June 2025. Patients were managed with IABO-assisted surgery ( n = 40) or UAE-assisted surgery ( n = 33) according to the pretreatment strategy used in routine clinical practice. Baseline characteristics, perioperative outcomes, hospitalization indicators, menstrual recovery, and subsequent reproductive outcomes were compared between groups. Because treatment allocation was nonrandomized, between-group findings were interpreted as observational associations. Results The groups differed in baseline fetal cardiac activity and ultrasonographic hypervascularity. Intraoperative blood loss, operative time, treatment conversion, treatment success, and readmission did not differ significantly between groups. Massive hemorrhage, defined as intraoperative blood loss ≥500 mL, occurred in 3 of 40 patients (7.5%) in the IABO group and 3 of 33 patients (9.1%) in the UAE group. The IABO group had a shorter hospital stay and lower hospitalization costs. Postoperative hypomenorrhea within 1 year was less frequent in the IABO group than in the UAE group. Subsequent pregnancy outcomes were described descriptively because of the small number of patients with follow-up pregnancies. Conclusion In this retrospective cohort, IABO and UAE showed broadly comparable perioperative hemostatic outcomes, while IABO was associated with shorter hospitalization, lower costs, and a lower frequency of postoperative hypomenorrhea. However, treatment allocation was nonrandomized and baseline differences indicated potential confounding by indication. Therefore, these findings should be interpreted as exploratory associations rather than evidence of comparative superiority.