Tohoku J. Exp. Med., 2005, 206(3)

Case Report

Successful Conservative Treatment of a Cesarean Scar Pregnancy with Uterine Artery Embolization

JUNICHI SUGAWARA, MASATO SENOO, HIROSHI CHISAKA, NOBUO YAEGASHI and KUNIHIRO OKAMURA

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan

Ectopic pregnancy developing in a previous Cesarean section scar is rare and is associated with catastrophic complications, such as uterine rupture and uncontrollable bleeding, which may lead to loss of the uterus. The operative treatments that have been reported for cesarean scar pregnancy are dilatation and curettage and excision of trophoblastic tissues using either laparotomy or laparoscopy. Recently, conservative treatment of scar pregnancy with locally and/or systemically administered methotrexate (MTX) has been reported. However, recent reports demonstrated that cases treated with MTX sometimes required laparotomy later because of excessive bleeding. In this series of cases we have demonstrated that viable cesarean scar pregnancies can be treated safely by selective transarterial embolization in combination with subsequent dilatation and curettage and local or systemic injections of MTX. In these three cases, uterine artery embolization proved to be a useful procedure for preventing uncontrollable bleeding and unnecessary uterine loss.

keywords —— cesarean scar pregnancy; conservative management; uterine artery embolization

© 2005 Tohoku University Medical Press

===============================

Correspondence: Junichi Sugawara, M.D., Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Tohoku University School of Medicine, 1-1 Seiryomachi, Aoba-ku, Sendai 980-8574, Japan.

e-mail: sugawara@mail.tains.tohoku.ac.jp