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Background: One of the most popular surgical procedures is the cesarean section (CS), and one of the most prevalent side effects of this procedure is wound and scar issues. The aim of this prospective, short-term, placebo-controlled study was to evaluate the safety and effectiveness of a silicone-based medical device (Lecoxen cream, Ekuberg Pharma, Carpignano Salentino, Italy) in healing wounds and scars derived from cesarean sections in nulliparous women. Methods: Seventy-four nulliparous women, ranging in age from 18 to 45, and underwent CSs, were divided in two groups of treatment (Lecoxen cream or Vaseline). The quality of scar was examined using the Vancouver scar scale after 28 days, while wound healing was evaluated using the Redness, Edema, Ecchymosis, Discharge, and Approximation (REEDA) scale on the 14th day following CS. Results: The treatment with Lecoxen cream determined a statistically significant improvement (p < 0.001) of the wound healing state, in terms of redness, edema, ecchymoses and discharge. Even about Vancouver Scar Scale (VSS) score there was a significative improvement in the observed group in terms of vascularization, pigmentation, flexibility and height (p < 0.001). No adverse effects were reported from the use of Lecoxen cream in participants. Conclusions: Lecoxen cream proved to be a safe and efficient treatment for wounds from CSs, making it a valuable topical to accelerate the healing process and reduce the visibility of scars. Clinical Trial Registration: The study was registered with the ISRCTN registry (https://www.isrctn.com/), registration number: ISRCTN51125312.

• Cesarean scar defects can result in secondary infertility and uterine rupture. • The defects showed thin residual myometrial thickness and/or complex shape. • Abdominal repair for cesarean scar defect had favorable reproductive outcomes. • Twin pregnancy (double blastocyst transfer) must be avoided in women with repair surgery. To clarify the reproductive outcomes of women who underwent abdominal repair surgery for cesarean scar defect (CSD). This is a retrospective observational study performed in a tertiary center. We retrospectively reviewed 20 women who underwent abdominal repair between 2007 and 2021. The indication for the repair was a minimal residual myometrial thickness (RMT) of ≦3.0 mm. We investigated surgical complications, changes in minimal RMT before and three-months after the repair, and reproductive outcomes. The median age at the time of repair was 36 years (27–40), with a median body mass index of 21.0 (17.7–28.7) and a median of 1 prior cesarean section (1–5). Twelve women reported secondary infertility, while eight women were concerned about the potential risk of uterine rupture in future pregnancies due to thin RMT. Additionally, one woman had a co-existing vesicouterine fistula, two had abscess and hematoma formation at the precedent cesarean section, and three showed remarkable dehiscence of the defect. The median minimal RMT significantly increased to 5.05 mm (range; 2.5–14.2 mm) after the repair. Seven women had a total of eight live births, with a median duration from the repair to a live-birth pregnancy of 11.5 months (range; 4–20 months). No surgical complications occurred during the repair, and there were no instances of uterine rupture in subsequent pregnancies. However, one woman who became pregnant with twins following double blastocyst transfer required a cesarean section at 25 weeks of pregnancy due to bulging towards the bladder side of the repaired CSD. Abdominal repair for CSD is feasible in women with thin RMT who experience secondary infertility. Twin pregnancies can promote thinning of the CSD repair site, potentially increasing the risk of uterine rupture. [ABSTRACT FROM AUTHOR]

Objective: To evaluate our experience in treatment of Caesarean Scar Pregnancy (CSP). Study Design: Cross Sectional Descriptive study. Setting: Department of Gynecology and Obstetrics, Independent Medical College Faisalabad. Period: Jan 2016 to Jan 2021. Material & Methods: The data for this study retrospectively obtained from outpatient department, emergency ward and labor ward registers. Data was analyzed by simple descriptive statics. Diagnosis of CSP was made by using transvaginal ultrasound and color flow Doppler ultrasound. Treatment offered was either medical management as systemic methotrexate or surgical as D&C or laparotomy. The aim was to do conservative treatment for fertility sparing. Patient age, gestational age at time of presentation, number of previous Cesarean Section and success of overall management strategy was analyzed. Results: In this study we had 12 patients diagnosed to have CSP with at least one scar on uterus of previous caesarean section. The mean age of patients was 32.5± 2 years and the gestational age range was from 5 weeks and 3 days to 10 weeks and 2 day. The diagnosis was done by using transvaginal ultrasound and color flow Doppler ultrasound. Which showed high velocity and low impedance flow in sub trophoblastic area. Out of 12 patient's 58.33 percent were treated with systemic methotrexate and had successful outcome. These were followed by B-hCG levels till non pregnant serum level of B-hCG of <5.1IU was achieved. 16.66 percent patients underwent D&C, but due to hemorrhage they were treated with laparotomy as supplementary procedure. 41.55 percent Patients were treated by laparotomy as their primary management with aim of fertility sparing surgery. The laparotomy was found to be successful treatment in all the patients who underwent surgical management as their primary treatment. Conclusion: Prompt diagnosis has pivotal role in reducing morbidity and mortality associated with CSP. Medical management is found to be successful at early gestational age. Fertility sparing surgery is better option as gestation advances more than 8 weeks to avoid undesirable outcome like hemorrhage and hysterectomy. [ABSTRACT FROM AUTHOR]

Background and Objectives: To investigate the prevalence of a Cesarean section (CS) scar niche during pregnancy, assessed by transvaginal ultrasound imaging, and to relate scar measurements, demographic and obstetric variables to the niche evolution and final pregnancy outcome. Materials and Methods: In this prospective observational study, we used transvaginal sonography to examine the uterine scars of 122 women at 11+0–13+6, 18+0–20+6 and 32+0–35+6 weeks of gestation. A scar was defined as visible on pregnant status when the area of hypoechogenic myometrial discontinuity of the lower uterine segment was identified. The CS scar niche (“defect”) was defined as an indentation at the site of the CS scar with a depth of at least 2 mm in the sagittal plane. We measured the hypoechogenic part of the CS niche in two dimensions, as myometrial thickness adjacent to the niche and the residual myometrial thickness (RMT). In the second and third trimesters of pregnancy, the full lower uterine segment (LUS) thickness and the myometrial layer thickness were measured at the thinnest part of the scar area. Two independent examiners measured CS scars in a non-selected subset of patients (n = 24). Descriptive analysis was used to assess scar visibility, and the intraclass correlation coefficient (ICC) was calculated to show the strength of absolute agreement between two examiners for scar measurements. Factors associated with the CS scar niche, including maternal age, BMI, smoking status, previous vaginal delivery, obstetrics complications and a history of previous uterine curettage, were investigated. Clinical information about pregnancy outcomes and complications was obtained from the hospital’s electronic medical database. Results: The scar was visible in 77.9% of the women. Among those with a visible CS scar, the incidence of a CS scar niche was 51.6%. The intra- and interobserver agreement for CS scar niche measurements was excellent (ICC 0.98 and 0.89, respectively). Comparing subgroups of women in terms of CS scar niche (n = 49) and non-niche (n = 73), there was no statistically significant correlation between maternal age (p = 0.486), BMI (p = 0.529), gestational diabetes (p = 1.000), smoking status (p = 0.662), previous vaginal delivery after CS (p = 1.000) and niche development. Uterine scar niches were seen in 56.3% (18/48) of the women who had undergone uterine curettage, compared with 34.4% (31/74) without uterine curettage (p = 0.045). We observed an absence of correlation between the uterine scar niche at the first trimester of pregnancy and mode of delivery (p = 0.337). Two cases (4.7%) of uterine scar dehiscence were confirmed following a trial of vaginal delivery. Conclusions: Based on ultrasonography examination, the CS scar niche remained visible in half of the cases with a visible CS scar at the first trimester of pregnancy and could be reproducibly measured by a transvaginal scan. Previous uterine curettage was associated with an increased risk for uterine niche formation in a subsequent pregnancy. Uterine scar dehiscence might be potentially related to the CS scar niche a subsequent pregnancy. [ABSTRACT FROM AUTHOR]

With an increased cesarean delivery rate, the incidence of abnormal placentation is steadily rising, and it is estimated to be around 1.7 per 1000 pregnancies for cesarean scar pregnancy and 1 per 500 pregnancies for placenta accreta spectrum disorder. Current evidence considers cesarean scar pregnancy and placenta accreta spectrum as being the same condition, with different aspects, of the same spectrum, having higher risks with advancing gestation. We present 7 cases, diagnosed and managed in our hospital, at different gestational ages. Early diagnosis is essential for appropriate counseling and subsequent management, and an ultrasound examination is the reference standard for diagnosis. Screening for an abnormally implanted placenta in the first trimester of pregnancy might improve the perinatal outcome and reduce maternal morbidity and mortality. [ABSTRACT FROM AUTHOR]

Choriocarcinoma and placental site trophoblastic tumor (PSTT) are rare varieties of gestational trophoblastic disease (GTD). PSTT alone constitutes about 1-2% of all trophoblastic tumors, which presents at early reproductive age and the serum beta-hCG level is much lower than choriocarcinoma. This tumor usually invades the myometrium and its depth of penetration is a prognostic factor. The first case report is regarding a 33-year-old woman with vaginal bleeding 3 months after abortion. The ultrasound exhibited heterogeneous and hypervascular mass related to previous cesarean scar. Serum beta-hCG level was 67 mIU/ml and chemotherapy was administered. However, due to severe vaginal bleeding and no regression in mass size, total abdominal hysterectomy was performed. Histopathological examination and IHC staining confirmed PSTT from previous cesarean section. The second case report is regarding a 33-year-old woman with cervicoisthmic choriocarcinoma, which was mistaken as cesarean scar pregnancy. The ultrasonography and elevated serum beta-hCG level suggested cesarean scar pregnancy. The patient was treated with methotrexate without any effect. Eventually, cervicoisthmic choriocarcinoma was detected after hysterectomy. A diagnostic error was made leading to possible uterus perforation along with incorrect chemotherapy that resulted in a life-threatening condition. It is concluded that PSTT and choriocarcinoma are the two important differential diagnoses of sustained elevated beta-hCG when imaging evidence is also suggestive. Although PSTT and cervicoisthmic choriocarcinoma are rare, they do exist and are on the rise.

Objectives: To analyze the effectiveness and outcome of conservative treatment in cases of abnormally located intrauterine pregnancies (cervical and cesarean scar).Study design: A retrospective analysis was performed of 30 pregnant women hospitalized due to abnormally located intrauterine pregnancies. The analyzed group comprised 24 pregnant women with abnormally located pregnancies. The patients were divided into two groups: the first group consisted of patients treated systemically with methotrexate, while the second of those treated locally by administration of methotrexate (MTX) and/or potassium chloride (KCl) by gestational sac puncture.Results: The analyzed group comprised 24 pregnant women with abnormally located pregnancies. Eight patients were diagnosed with cervical pregnancy (CP) and 16 patients were diagnosed with cesarean scar pregnancy (CSP). Six patients were excluded from the study: two with spontaneous abortions, two heterotopic pregnancies, and two cornual pregnancies. Twelve analyzed patients underwent MTX systemic administration (five patients with CP, seven with CSP). In five patients, systemic treatment was ineffective; they were qualified for additional local therapy with gestational sac (GS) puncture and MTX or KCl administration to the sac and additional administration of MTX to the trophoblast area. In second group of 12 patients (three CP, nine CSP), local treatment (GS puncture with MTX or MTX + KCl) was used as the first line treatment. One patient underwent combined treatment (local + systemic).Conclusions: Conservative treatment should be the gold standard procedure in abnormally located intrauterine pregnancies. It is noticeable that MTX / KCl is more effective in a direct administration to the GS. In four cases, systemic MTX did not produce the desired effects. In these cases, the treatment was assisted by local administration of MTX or KCl, resulting in the termination of an abnormally located pregnancy. [ABSTRACT FROM AUTHOR]

A 35 years old woman presented at 8-week gestation for her first prenatal visit. She had no complaints at the time. While her past obstetrical history showed two prior cesarean sections. Transvaginal ultrasound was performed showing fortuitously a cesarean scar ectopic pregnancy with a gestational sac implanted in the myometrium between the bladder and the anterior wall of the uterus (A) and associated with a periovulatory hyper-vascularization in color doppler (B). This aspect was confirmed in 3D Ultrasound which showed a gestational sac bulging through the anterior wall of the uterus into the bladder with diminished myometrial layer between the bladder and the sac (C). The outcome was favorable after conservative surgical treatment by laparotomy associated with a triple preventive ligation because of the high risk of bleeding. Cesarean scar pregnancy is so a rare iatrogenic complication of cesarean section; however, her incidence is actually growing due to the increase in cesarean section rates. The diagnosis is usually made via ultrasound showing an empty uterine cavity and cervical canal, a gestational sac located anteriorly at the isthmus, and evidence of a functional trophoblastic/placental circulation on color Doppler. Early diagnosis is crucial to avoid severe vital and functional complications such as hemorrhage, early uterine rupture and hysterectomy, so its recognition is important to keep fertility of young woman.

Choriocarcinoma and placental site trophoblastic tumor (PSTT) are rare varieties of gestational trophoblastic disease (GTD). PSTT alone constitutes about 1-2% of all trophoblastic tumors, which presents at early reproductive age and the serum betahCG level is much lower than choriocarcinoma. This tumor usually invades the myometrium and its depth of penetration is a prognostic factor. The first case report is regarding a 33-year-old woman with vaginal bleeding 3 months after abortion. The ultrasound exhibited heterogeneous and hypervascular mass related to previous cesarean scar. Serum beta-hCG level was 67 mIU/ml and chemotherapy was administered. However, due to severe vaginal bleeding and no regression in mass size, total abdominal hysterectomy was performed. Histopathological examination and IHC staining confirmed PSTT from previous cesarean section. The second case report is regarding a 33-year-old woman with cervicoisthmic choriocarcinoma, which was mistaken as cesarean scar pregnancy. The ultrasonography and elevated serum beta-hCG level suggested cesarean scar pregnancy. The patient was treated with methotrexate without any effect. Eventually, cervicoisthmic choriocarcinoma was detected after hysterectomy. A diagnostic error was made leading to possible uterus perforation along with incorrect chemotherapy that resulted in a life-threatening condition. It is concluded that PSTT and choriocarcinoma are the two important differential diagnoses of sustained elevated beta-hCG when imaging evidence is also suggestive. Although PSTT and cervicoisthmic choriocarcinoma are rare, they do exist and are on the rise. [ABSTRACT FROM AUTHOR]

The management of incisional hernia in pregnancy is mainly conservative. A Caesarean section in a woman with a large incisional hernia offers a means of hernia repair during the operation. We report a case of full term pregnancy in a third gravida aged 36 years who had previous two cesarean sections through the midline scar. Incisional hernia developed as a complication because of the previous operations. Cesarean section with bilateral tubal ligation was done with repair of the incisional hernia with nonabsorbable sutures. The post-operative recovery was uneventful. During emergency operations including cesarean sections, surgical principles should always be observed in order to prevent the occurrence of incisional hernias. [ABSTRACT FROM AUTHOR]

Objective To demonstrate the efficacy of placement and inflation of Foley balloon catheters prophylactically to prevent, or as an adjuvant therapy to control, bleeding in women undergoing treatment for Cesarean scar pregnancy (CSP) or cervical pregnancy (CxP). Methods This was a retrospective study of 18 women with either CSP (n = 16) or CxP (n = 2), who underwent Foley balloon catheter placement under continuous transvaginal or transabdominal ultrasound guidance to prevent or manage bleeding following treatment, which in most cases comprised local (intragestational sac) and intramuscular (IM) methotrexate (MTX) injections. In eight cases, the balloon catheter was placed immediately following local and/or IM MTX treatment, either because of bleeding or prophylactically; in eight cases, the catheter was placed as part of a two-step protocol, with patients first treated with local and IM MTX injection, then suction aspiration on Day 4 or 5, followed by planned insertion of a balloon catheter; in one patient the balloon was placed on Day 21 after local and IM MTX treatment, due to sudden bleeding; and in one case of a heterotopic pregnancy, one intrauterine and one cervical, the balloon was placed due to severe bleeding. Human chorionic gonadotropin (hCG) levels were evaluated weekly following MTX injection. Results Gestational ages at balloon placement ranged between 5 and 12+2weeks. All embryos/fetuses, with the exception of the cervical heterotopic one, had heart activity and catheter placement was well-tolerated by all women. The balloon tamponade effectively reduced or prevented maternal vaginal bleeding in all except one patient; this woman had a heterotopic CxP and required abdominal robotic cerclage to control the bleeding. Catheterswere kept in place for a mean of 3.6 (range, 1-6) days. hCG levels returned to low or zero levels within 19-82 days following MTX injection. Fifteen women required antibiotic treatment following the procedure. One woman with CSP developed an arteriovenous malformation requiring uterine artery embolization. Conclusion Ultrasound-guided placement and inflation of Foley balloon catheters was easy to perform and well-tolerated by patients undergoing treatment for CSP or CxP, and successfully prevented or helped in the management of bleeding complications. Based on our experience and previous publications we suggest having the option of balloon catheter insertion available when local treatment of CSP or CxP is undertaken. [ABSTRACT FROM AUTHOR]

Purpose: To estimate the risk of uterine dehiscence/rupture in women with previous cesarean section (CS) by comparing the thickness of lower uterine segment (LUS) and myometrium with trans-abdominal (TAS) and trans-vaginal sonography (TVS). Method: In this case-control study, in 100 pregnant women posted for elective CS (with or without previous CS; group 1 and group 2 respectively), the thickness of LUS and myometrium was measured sonographically (TAS and TVS). Intra-operatively, LUS was graded (grades I-IV), and its thickness was measured with calipers. The primary outcome of the study was correlation between echographic measurements (TAS and TVS) and features of LUS (grades I-IV) at the time of CS. Secondary outcomes were correlation between myometrial thickness, number of previous CS, and inter-delivery interval with LUS (grades I-IV). Results: Sonographic measurements of LUS and myometrium were significantly different between the two groups (both TAS and TVS p value = 0.000 each). However, the number of previous CS ( p = 0.440) and inter-delivery interval ( p = 0.062) had no statistically significant correlation with thickness of LUS. Conclusions: Sonographic evaluation of LUS scar and myometrial thickness (both with TAS and TVS) is a safe, reliable, and non-invasive method for predicting the risk of scar dehiscence/rupture. Specific guidelines for TOLAC, after sonographic assessment of women with previous CS, are need of the hour. [ABSTRACT FROM AUTHOR]

Aim To assess three different methods in treating patients with cesarean scar pregnancy ( CSP). Methods We evaluated pre-, intra- and postoperative conditions of 124 CSP patients in one of the three treatment groups, of which 37 patients underwent uterine curettage by hysteroscopy under ultrasound monitoring (group 1), 28 patients were treated with methotrexate followed by hysteroscopy (group 2) and 59 cases underwent uterine arterial embolization followed by hysteroscopy (group 3). The treatment options were determined based on the patients' conditions. Results Among all three groups, group 3 (uterine arterial embolization followed by hysteroscopy) had the least intraoperative blood loss and the highest success rate with curettage, but the highest hospitalization cost. Group 1 (only hysteroscopy) had the shortest length of hospitalization and the lowest cost, but the highest intraoperative blood loss and slowest recovery. Group 2 (methotrexate followed by hysteroscopy) had the longest period of hospitalization, and other indexes had fallen in between the other two groups. Conclusion Among the three methods, uterine arterial embolization followed by hysteroscopy is the safest and most efficient method without considering the cost of hospitalization. Patients with a low level of β-h CG may consider choosing hysteroscopy under ultrasound monitoring or methotrexate followed by hysteroscopy. The advantage is low cost of hospitalization; however, patients may be under relatively higher surgical risks and lower first time surgical success rate, especially for patients treated by hysteroscopy under ultrasound monitoring. [ABSTRACT FROM AUTHOR]

Implantation of an embryo within the scar of a previous cesarean delivery is one of the rare forms of ectopic pregnancy (EP). There are two types of such pregnancies: type 1, in which the embryo starts to progress towards the uterine cavity and may result in live birth despite the high risk of a hemorrhage occurring during birth, and type 2, which consists of pregnancies in which the embryo is embedded deep within the cesarean scar (CS) and grows towards the bladder and abdominal cavity, which is very dangerous and needs to be terminated immediately. There are very few cases in the literature reporting live birth as a result of such pregnancies. Here, we present a 41-year-old single gravid woman who had been treated for infertility at our institute and had eventually conceived through embryonic transfer freezing. At six weeks, a transvaginal scan showed the presence of an EP within the CS but despite this finding the pregnancy was continued to term. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical effects in women with cesarean scar pregnancy (CSP) who were treated with either methotrexate (MTX) regimen only or MTX regimen followed by dilation and curettage (D&C).Design: Prospective consecutive clinical cohort study.Setting: University hospital for obstetrics, gynecology, and reproductive medicine.Subject(s): Seventy-one cases of CSP.Intervention(s): The subjects were treated with either MTX only (MTX group, 21 cases) or MTX followed by D&C (combined therapy group, 50 cases).Main Outcome Measure(s): Success rates, hysterectomy rates, and time to resolution of serum beta-hCG and the CSP mass were compared between the two groups.Result(s): Compared with the MTX group, the combined therapy group had a shorter time to resolution of the CSP mass and serum beta-hCG. There was no significant difference between the MTX and combined therapy groups regarding success rates (76.2% vs. 90.0%, respectively) and hysterectomy rates (19.0% vs. 8.0%, respectively).Conclusion(s): Both therapies could treat the majority of CSP patients successfully, but the combined therapy resulted in a shorter time of therapy and indicated a more favorable effect. [ABSTRACT FROM AUTHOR]

Objective To investigate whether uterine contractions at the time of a Cesarean section have an impact on future presence and location of a cervical Cesarean scar. Methods A targeted transvaginal ultrasound examination of the fetus, uterus and cervix was done in 2973 consecutive women at 14–16 weeks' gestation. The sonographer was blinded to the women's previous obstetric histories. The presence and location of a sonographic cervical hypoechogenic line, which probably represented a Cesarean scar, was recorded. Results There were 180 women with a previous Cesarean section performed before the start of uterine contractions and 173 with a Cesarean section performed during contractions in labor. The cervical hypoechogenic line was more common in sections performed during contractions (75.7% vs. 52.7%; P < 0.001) and was more distally located from the internal os (17.9 ± 9.4 vs. 14.6 ± 9.1 mm; P = 0.01). A hypoechogenic line was observed in 21/2620 women without a previous Cesarean section, representing a false-positive rate of 0.8%. Conclusion Cesarean sections, especially those done during uterine contractions, are actually performed through cervical tissue. This finding is in agreement with the physiological process of cervical effacement during contractions. [ABSTRACT FROM AUTHOR]

Background: Cesarean scar pregnancy is rare but may be related to early uterine rupture and may result in massive hemorrhage. Nowadays, most cesarean scar pregnancies are diagnosed early and can be managed properly. However, diagnoses of cesarean scar pregnancies that develop in the obstetrical area are sometimes delayed.Case Presentation: A 28-year-old Asian woman visited our institution because of suspected cesarean scar pregnancy. Ultrasonography and computed tomography confirmed a cesarean scar pregnancy with a live fetus with a crown-rump length of 4.83 cm, corresponding to 11 weeks 6 days of gestation. Initially, we injected 50 mg of methotrexate in the amniotic sac under transabdominal ultrasonographic guidance. However, fetal cardiac activity was still observed 2 days later. We decided to perform open laparotomy because of the possibility of massive bleeding. The gestational sac was removed, as well as most of the trophoblastic tissues that were adherent and invading the wall of the lower uterine segment. She was discharged in good condition 5 days after the operation.Conclusions: Despite the popular use of ultrasonography in prenatal care, diagnosis of cesarean scar pregnancy is still delayed. Surgical treatment with local methotrexate injection could be an option for the management of advanced cesarean scar pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To report a cesarean scar pregnancy (CSP) with a coexistent viable intrauterine pregnancy. Design: Case report. Setting: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan. Patient(s): A 31-year-old woman, with previous cesarean delivery, presented with vaginal bleeding, was transferred to our hospital at 7 weeks'' gestation for heterotopic pregnancy after an IVF–embryo transfer. A diagnosis of intrauterine pregnancy combined with CSP was made by ultrasonography. Intervention(s): Hysteroscopic-directed evacuation of CSP. Main Outcome Measure(s): Good hemostasis at cesarean site and ongoing intrauterine pregnancy. Result(s): A healthy baby was delivered by cesarean delivery at term. Conclusion(s): With the increasing number of IVF–embryo transfers, the amount of heterotopic pregnancies is also increasing. Hysteroscopic management of CSP is a minimally invasive procedure that leads to successful obstetric outcomes in the corresponding intrauterine pregnancies. [Copyright &y& Elsevier]

Objective: The objective of the study was to compare the efficacy and safety of uterine artery embolization (UAE) vs systemic methotrexate (MTX) for pregnancy within a cesarean scar. Study Design: Seventy-two women with pregnancy within cesarean scar were randomly allocated to a UAE group (37 cases) or an MTX group (35 cases), which all was followed by suction curettage. The primary outpoints include bleeding loss, serum β-human chorionic gonadotropin level, and side effects. Results: The bleeding volumes were 36.93 ± 6.01 mL in the UAE group and 415.63 ± 68.37 mL in the MTX group (P < .001). The hospitalization time was 11.73 ± 0.80 days in the UAE group and 39.63 ± 4.57 days in the MTX group (P < .001). There was no severe side effect in both groups. Conclusion: For pregnancy within a cesarean scar, UAE followed by suction curettage appears to have more advantage and may be a priority option. [Copyright &y& Elsevier]