title: Uterine artery embolization with methotrexate infusion as treatment for cesarean scar pregnancy. Case report.
abstract: Cesarean scar pregnancy is a rare form of ectopic pregnancy. It is associated with many complications, including a high risk of massive bleeding and hysterectomy under unfavorable conditions. Conservative treatment with systemic methotrexate (MTX) has been used preferentially with the aim of allowing the patient to have a reproductive future. However, cases of complex ectopic masses in a cesarean scar with guarded prognosis demand techniques that are more effective, such as uterine artery embolization (UAE) in association with intra-arterial MTX infusion. We describe the case of a 35-year-old patient in the 8th week of pregnancy who was referred to us because of genital bleeding and suspected ectopic pregnancy in the cesarean scar. After confirmation of the diagnosis, an initial attempt at systemic treatment with MTX was made. This was abandoned due to the elevation of the hepatic transaminase level. In addition, because of the complexity of the mass and the patient's desire to preserve her reproductive capacity, it was decided to perform UAE with local MTX infusion. The procedure was performed successfully and the patient's fertility was preserved.
authors: Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo-SP, Brazil.
authors: Julio
authors: J
authors: Elito Júnior
authors: Edward
authors: E
authors: Araujo Júnior
authors: Eduardo Félix
authors: EF
authors: Martins Santana
authors: Denis
authors: D
authors: Szejnfeld
authors: Talita Micheletti
authors: TM
authors: Helfer
authors: Luciano Marcondes Machado
authors: LM
authors: Nardozza
authors: Antonio Fernandes
authors: AF
authors: Moron
mesh_terms: D000019:Abortifacient Agents / Q000008:administration & dosage; D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal / Q000379:methods; D055357:Uterine Artery Embolization / Q000379:methods*
chemical_list: D000019:Abortifacient Agents; D008727:Methotrexate