title: Conservative management of cesarean scar pregnancy with uterine arteriovenous malformation: a case report.
abstract: BACKGROUND
  Cesarean scar pregnancy is a rare type of ectopic pregnancy in which implantation occurs in a previous lower segment cesarean scar. It may be associated with uncontrolled hemorrhage ending in hysterectomy. It can become potentially life threatening for the patient when it further gets complicated by uterine arteriovenous malformation (AVM). To the best of our knowledge there are only a few previous reports of AVM complicating a scar pregnancy. It is still unclear which treatment is most optimal.
  
  
  METHODS
  We describe a case of a scar pregnancy complicated by uterine AVM. The diagnosis was made using 3D color Doppler ultrasound, showing a highly vascular tumor in the isthmic region of the uterus. Computed tomography angiography supported the diagnosis. The patient underwent selective embolization of the uterine artery followed by weekly intramuscular injections of methotrexate. Recovery was uneventful.
  
  
  CONCLUSIONS
  The decision regarding mode of treatment should be made by the patient and the clinician based on the local expertise and experience. Judicious use of medical management (methotrexate) and uterine artery embolization may prevent hysterectomy and allow preservation of fertility.
authors: Department of Obstetrics and Gynecology, Lady Hardinge Medical College, New Delhi, India. drpuneet.k20@gmail.com
authors: Puneet Kaur
authors: PK
authors: Kochhar
authors: Monica
authors: M
authors: Sarangal
authors: Usha
authors: U
authors: Gupta
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use; D001165:Arteriovenous Malformations / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D002585:Cesarean Section / Q000009:adverse effects; D002921:Cicatrix / Q000150:complications*; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000209:etiology / Q000628:therapy*; D014463:Ultrasonography; D055988:Uterine Artery; D055357:Uterine Artery Embolization
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate