title: Uterine artery embolization combined with methotrexate in the treatment of cesarean scar pregnancy: results of a case series and review of the literature.
abstract: OBJECTIVE
  To explore the clinical value of uterine artery embolization (UAE) combined with methotrexate in the treatment of cesarean scar pregnancy (CSP) before and after uterine curettage.
  
  
  METHODS
  From August 2009 to April 2012, 15 patients with CSP treated with UAE (before or after uterine curettage) were analyzed retrospectively. Eleven subjects with a definite diagnosis of CSP were offered preventive UAE combined with methotrexate before uterine curettage. The other four patients, who were misdiagnosed as having an intrauterine pregnancy, were treated with emergency UAE for uncontrollable massive hemorrhage after uterine curettage. Clinical data, treatment sequence, and outcome were analyzed, and a brief review of the published literature summarizing UAE in the treatment of CSP was performed.
  
  
  RESULTS
  Eleven patients with definite CSP received preventive UAE combined with methotrexate followed by uterine curettage, and CSP was resolved successfully without hysterectomy. In the four misdiagnosed patients, three were treated successfully with emergency UAE. The other patient underwent uterine curettage and emergency UAE followed by repeat curettage, but hysterectomy was performed because of continued severe hemorrhage.
  
  
  CONCLUSIONS
  Based on a small number of patients, it appears that UAE may be an effective means of treating CSP, including treatment in an emergency setting. Further study is required before the safety and effectiveness of UAE can be confirmed.
authors.affiliation: Department of Radiology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Zhang
authors.forename: Zai-Bo
authors.initials: ZB
authors.lastname: Jiang
authors.forename: Ming-Sheng
authors.initials: MS
authors.lastname: Huang
authors.forename: Shou-Hai
authors.initials: SH
authors.lastname: Guan
authors.forename: Kang-Shun
authors.initials: KS
authors.lastname: Zhu
authors.forename: Jie-Sheng
authors.initials: JS
authors.lastname: Qian
authors.forename: Bin
authors.initials: B
authors.lastname: Zhou
authors.forename: Ming-An
authors.initials: MA
authors.lastname: Li
authors.forename: Hong
authors.initials: H
authors.lastname: Shan
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix / Q000150:complications*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000209:etiology* / Q000628:therapy*; D016896:Treatment Outcome; D055357:Uterine Artery Embolization / Q000379:methods*
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate