Methotrexate-based bilateral uterine arterial chemoembolization for treatment of cesarean scar pregnancy.

We have evaluated the efficacy of methotrexate-based bilateral uterine arterial chemoembolization for treating cesarean scar pregnancy (CSP) in 52 women between January 2005 and December 2009. Ten patients experienced massive vaginal hemorrhage after a misdiagnosis and subsequent curettage. Bleeding in these patients was reduced after chemoembolization. Dilation and curettage was not done in five of these patients because ultrasound scanning showed sparse or no blood flow in the previous gestational sac area. The five remaining patients, along with additional 42 patients who were diagnosed with CSP, underwent ultrasound-guided dilation and curettage within 24-48 hours following chemoembolization. Patients tolerated the procedure well and only mild bleeding occurred. The positive clinical outcomes in these patients support the use of bilateral uterine artery chemoembolization for the treatment of CSP.