Archives of Gynecology and Obstetrics

, Volume 297, Issue 5, pp 1205–1211 | Cite as

A retrospective comparative study evaluating the efficacy of adding intra-arterial methotrexate infusion to uterine artery embolisation followed by curettage for cesarean scar pregnancy

  • Ling Gao
  • Yan-yan Hou
  • Feng Sun
  • Wei Xia
  • Yi Yang
  • Tian Tian
  • Qin-fang Chen
  • Xiao-cui Li
General Gynecology



The study aimed to compare the efficacy of intra-arterial methotrexate (MTX) infusion combined with uterine artery embolisation (UAE) and uterine curettage with that of UAE and curettage without MTX infusion for the treatment of cesarean scar pregnancy (CSP).


In this retrospective study, data of CSP patients admitted from January 2011 to July 2015 were obtained from electronic patient records. Clinical information at baseline and after treatment were extracted and analyzed.


A total of 93 CSP patients were included, with 57 patients receiving UAE followed by curettage (UC) and 36 patients receiving intra-arterial MTX infusion followed by UAE and curettage (MUC). The baseline characteristics were not significantly different between the two groups. Without additional intervention, 32 (88.9%) patients were successfully treated by MUC, and 49 (86.0%) patients were successfully treated by UC, defined by discontinued ectopic conceptus growth, normalized serum β-human chorionic gonadotropin (β-hCG) level, ceased vaginal bleeding and preservation of uterus, with no significant difference between the two groups. Additionally, intra-operative blood loss volume and post-operative bleeding events were not significantly different between the two groups. However, serum β-hCG decline on the first day after surgery was significantly promoted, and the hospitalization length and the time needed for serum β-hCG normalization were significantly shortened by addition of intra-arterial MTX infusion.


Adding intra-arterial MTX to UAE and curettage significantly promoted post-operative recovery, though success rate and bleeding events were not significantly affected, suggesting that addition of intra-arterial MTX might not be necessary.


Cesarean scar pregnancy Uterine artery embolisation Methotrexate Fertility Uterine curettage 


Author contributions

LG: collected and analyzed the data, drafted the manuscript; YYH: collected the data and analyzed the data; FS: analyzed the data and reviewed the draft; WX: analyzed the data; YY: prepared figures and tables; TT: prepared figures; QFC: supervised the study, reviewed and edited the manuscript; XCL: designed the study, supervised the study, reviewed and edited the manuscript.


This study was funded by the National Natural Science Foundation of China (81601238), and Shanghai Municipal Commission of Health and family planning (20164Y0251).

Compliance with ethical standards

Conflict of interest

The authors declared that they had no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study before treatment.


  1. 1.
    Yang H, Li S, Ma Z, Jia Y (2016) Therapeutic effects of uterine artery embolisation (UAE) and methotrexate (MTX) conservative therapy used in treatment of cesarean scar pregnancy. Arch Gynecol Obstet 293:819–823CrossRefPubMedGoogle Scholar
  2. 2.
    Liu W, Shen L, Wang Q, Wang W, Sun Z (2016) Uterine artery embolization combined with curettage vs. methotrexate plus curettage for cesarean scar pregnancy. Arch Gynecol Obstet 294:71–76CrossRefPubMedGoogle Scholar
  3. 3.
    Kong D, Dong X, Qi Y (2015) Ultrasonography-guided multidrug stratification interventional therapy for cesarean scar pregnancy. Arch Gynecol Obstet 292:143–148CrossRefPubMedGoogle Scholar
  4. 4.
    Parker VL, Srinivas M (2016) Non-tubal ectopic pregnancy. Arch Gynecol Obstet 294:19–27CrossRefPubMedGoogle Scholar
  5. 5.
    Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR (2016) The increasing trend in caesarean section rates: global, regional and national estimates: 1990–2014. PLoS One 11:e0148343CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Wang JH, Qian ZD, Zhuang YL, Du YJ, Zhu LH, Huang LL (2013) Risk factors for intraoperative hemorrhage at evacuation of a cesarean scar pregnancy following uterine artery embolization. Int J Gynaecol Obstet 123:240–243CrossRefPubMedGoogle Scholar
  7. 7.
    Kanat-Pektas M, Bodur S, Dundar O, Bakir VL (2016) Systematic review: what is the best first-line approach for cesarean section ectopic pregnancy? Taiwan J Obstet Gynecol 55:263–269CrossRefPubMedGoogle Scholar
  8. 8.
    Pereira N, Elias RT (2016) Conservative management of cesarean scar pregnancy following diagnosis via magnetic resonance imaging. J Minim Invasive Gynecol 24:520–521CrossRefPubMedGoogle Scholar
  9. 9.
    Peng P, Gui T, Liu X, Chen W, Liu Z (2015) Comparative efficacy and safety of local and systemic methotrexate injection in cesarean scar pregnancy. Ther Clin Risk Manag 11:137–142PubMedPubMedCentralGoogle Scholar
  10. 10.
    Yin X, Su S, Dong B, Ban Y, Li C, Sun B (2012) Angiographic uterine artery chemoembolization followed by vacuum aspiration: an efficient and safe treatment for managing complicated cesarean scar pregnancy. Arch Gynecol Obstet 285:1313–1318CrossRefPubMedGoogle Scholar
  11. 11.
    Timor-Tritsch IE, Monteagudo A (2012) Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy. A review. Am J Obstet Gynecol 207:14–29CrossRefPubMedGoogle Scholar
  12. 12.
    Wang CB, Tseng CJ (2006) Primary evacuation therapy for cesarean scar pregnancy: three new cases and review. Ultrasound Obstet Gynecol 27:222–226CrossRefPubMedGoogle Scholar
  13. 13.
    Deans R, Abbott J (2010) Hysteroscopic management of cesarean scar ectopic pregnancy. Fertil Steril 93:1735–1740CrossRefPubMedGoogle Scholar
  14. 14.
    Qian ZD, Huang LL, Zhu XM (2015) Curettage or operative hysteroscopy in the treatment of cesarean scar pregnancy. Arch Gynecol Obstet 292:1055–1061CrossRefPubMedGoogle Scholar
  15. 15.
    Wu X, Xue X, Wu X, Lin R, Yuan Y, Wang Q, Xu C, He Y, Hu W (2014) Combined laparoscopy and hysteroscopy vs. uterine curettage in the uterine artery embolization-based management of cesarean scar pregnancy: a cohort study. Int J Clin Exp Med 7:2793–2803PubMedPubMedCentralGoogle Scholar
  16. 16.
    Faul F, Erdfelder E, Lang AG, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39:175–191CrossRefPubMedGoogle Scholar
  17. 17.
    Lan W, Hu D, Li Z, Wang L, Yang W, Hu S (2013) Bilateral uterine artery chemoembolization combined with dilation and curettage for treatment of cesarean scar pregnancy: a method for preserving the uterus. J Obstet Gynaecol Res 39:1153–1158CrossRefPubMedGoogle Scholar
  18. 18.
    Feng Y, Chen S, Li C, Zhang X, Duan H, Sooranna S, Johnson MR, Li J (2016) Curettage after uterine artery embolization combined with methotrexate treatment for caesarean scar pregnancy. Exp Ther Med 12:1469–1475CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Qi F, Zhou W, Wang MF, Chai ZY, Zheng LZ (2015) Uterine artery embolization with and without local methotrexate infusion for the treatment of cesarean scar pregnancy. Taiwan J Obstet Gynecol 54:376–380CrossRefPubMedGoogle Scholar
  20. 20.
    Sadeghi H, Rutherford T, Rackow BW, Campbell KH, Duzyj CM, Guess MK, Kodaman PH, Norwitz ER (2010) Cesarean scar ectopic pregnancy: case series and review of the literature. Am J Perinatol 27:111–120CrossRefPubMedGoogle Scholar
  21. 21.
    Cottier JP, Fignon A, Tranquart F, Herbreteau D (2002) Uterine necrosis after arterial embolization for postpartum hemorrhage. Obstet Gynecol 100:1074–1077PubMedGoogle Scholar
  22. 22.
    Godfrey CD, Zbella EA (2001) Uterine necrosis after uterine artery embolization for leiomyoma. Obstet Gynecol 98:950–952PubMedGoogle Scholar
  23. 23.
    Tulpin L, Morel O, Malartic C, Barranger E (2009) Conservative management of a cesarean scar ectopic pregnancy: a case report. Cases J 2:7794CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Family Planning, The International Peace Maternity and Child Health Hospital, School of MedicineShanghai Jiao Tong UniversityShanghaiChina
  2. 2.Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, School of MedicineTong Ji UniversityShanghaiChina
  3. 3.The Second Clinical Medical CollegeTianjin Medical UniversityTianjinChina

Personalised recommendations