Uterine artery embolization as an initial intervention for caesarean scar pregnancy, followed by suction evacuation: a conservative treatment approach.

Objectives. Currently, there is no established gold standard for the treatment of caesarean scar pregnancy (CSP). This study aims to propose a new standard of care for managing CSP. Caesarean scar pregnancy is classified into two types: type 1 (on the scar) and type 2 (in the niche). There is currently no international standard for predicting invasion extent or for determining the most effective management approach for CSP. Materials and method. Our protocol involved intramuscular methotrexate injection, followed by uterine artery embolization and suction evacuation as part of a conservative approach. This protocol was applied to seven patients diagnosed with CSP. Only patients with caesarean scar pregnancy at an early gestational age (≤9 weeks) who provided written consent for the combined treatment method were included. Results. All cases had positive outcomes, without any complications such as uterine perforation, emergency hysterectomy, severe hemorrhage or endometritis. Early diagnosis of CSP and the location of invasive trophoblast opposite the uterine scar were significant predictors for a favorable outcome. Conclusions. This series of CSP cases demonstrates that the combination of systemic methotrexate and uterine artery embolization ensures effective and minimally invasive management of caesarean scar pregnancy. This treatment protocol is suitable for both types of CSP. The early identification of pregnancy location, particularly after caesarean delivery, should be mandatory to prevent CSP-related complications. [ABSTRACT FROM AUTHOR]