Purpose: Cesarean Scar Pregnancy (CSP) is relatively rare, yet life-threatening condition where the embryo is implanted in the scar after cesarean section. Along with the increasing number of cesarean deliveries the problem is gaining on importance. Authors present clinical outcome of Uterine Artery Chemoembolization with Methotrexate and Gelatine Sponge for the treatment of CSP and causes of procedural failure as well as literature overview.
Material and Methods: Forty-one patients with CSP diagnosed with transvaginal ultrasound examination (TVUS) were referred to Department of Interventional Radiology between January 2013 and March 2019. All patients were treated with selective chemoembolization of uterine arteries with mixture of methotrexate and gelatine sponge.
Results: Primary procedure failed in 7 out of 41 (17%) cases. In 4 cases additional blood supply to the CSP was disclosed; three out of four from ovarian artery and one from superior vesical artery. In other 3 patients reperfusion of uterine arteries was observed. All these 7 patients underwent successful secondary embolization. Twelve patients expressed the desire for subsequent pregnancy. From this group five conceived within a year after the procedure. The rest did not achieve a pregnancy during evaluated time.
Conclusions: Uterine Artery Chemoembolization proved to be safe and effective method and should be considered as an option for CSP treatment especially for women willing to preserve their fertility. However, the presence of collateral blood supply should always be considered.