The effects of methotrexate and uterine arterial embolization in patients with cesarean scar pregnancy: A retrospective case-control study

In this study, we explored the optimal treatment for cesarean scar pregnancy (CSP). One hundred three women diagnosed with CSP received 1 of the 3 treatments: local or systemic methotrexate (MTX) injection and surgery (MTX+Surg), uterine arterial embolization (UAE) and surgery (UAE+Surg) or surgery only (Surg only). We compared their therapeutic effects and their follow-up results. There was no significant difference between the groups in the baseline of clinical characteristic except for the initial human chorionic gonadotropin levels, which was highest in the MTX+Surg group (median, [interquartile range]), (120,004 [16,720-181,727] mIU/mL), compared to the UAE+Surg group (38,219 [23,194-100,029] mIU/mL) and Surg only group (22,557 [9113-49,573] mIU/mL). There was no significant difference between groups in the sonographic characteristic of patients. The intraoperative hemorrhage was highest in the Surg-only group (7/42, 16.67%), compared to the MTX+Surg group (4/26, 15.38%) and the UAE+Surg group (0/35, 0%). The incidence of intrauterine adhesions was highest in the UAE+Surg group (20%), compared to the MTX+Surg group (0%) and the Surg only group (0%). The incidence of embryo residue was highest in Surg-only group (21.43%), compared to the MTX+Surg group (0%) and the UAE+Surg group (2.86%). To conclude, MTX injection plus surgery might be the best treatment for CSP patients.