Uterine artery embolization and intra-arterial methotrexate for management of cesarean scar pregnancy: A case series

Introduction Cesarean scar pregnancy (CSP) is a life-threatening condition whose incidence is increasing worldwide. There is currently no consensus on the optimal management of CSP, although many fertility-sparing approaches have been proposed. Uterine artery embolization (UAE), with or without intra-arterial Methotrexate (IA-MTX), seems to be a safe option to prevent hysterectomy and preserve fertility. Methods A series of nine cases of CSP treated with UAE and IA-MTX, diagnosed at our university center between January 2019 and May 2025. Clinical data were obtained by reviewing paper and electronic medical records. Results UAE plus IA-MTX was effective in treating CSP in 78% of cases. Treatment failure was subsequent to high levels of beta-HCG and substantial CSP vascularization, resulting from a delayed diagnosis. There were no cases of hysterectomy. All patients resumed normal menstrual function after treatment. There were four subsequent pregnancies out of six patients with childbearing desire: three gestations had a regular course with term delivery, whereas one was a spontaneous miscarriage. Discussion UAE with IA-MTX appears a safe and effective procedure for CSP treatment. By reducing the risk of hysterectomy, it can help preserving fertility. Further larger prospective studies are needed.