Conservative treatment for Caesarean scar pregnancy: uterine artery embolisation followed by suction evacuation

Currently, there has not been established a gold standard in treating Caesarean scar pregnancy (CSP), the purpose of this study being to propose a new standard of care for the management of CSP. The actual classification of the CSP includes two types: type 1 (on the scar) and type 2 (in the niche). So far, there has not been implemented an international standard in order to predict the invasion extent or the most favourable CSP management. Our protocol included intramuscular methotrexate injection with subsequent uterine artery embolisation followed with suction evacuation with regard to a conservative approach. We used this protocol to treat seven patients who were diagnosed with CSP. We included patients with CSP, at an early gestational age (≤ 9 weeks), who gave us their written consent for this combined treatment method. We had positive outcome in all cases, with no complications (uterine perforation, emergency hysterectomy, severe hemorrhage or infection - endometritis). Early diagnosis of CSP and the location of the invasive trophoblast opposite to the uterine scar were the most significant predictors for a favourable outcome. The primary conclusion from this series of CSP cases is represented by the association of systemic methotrexate with uterine artery embolisation ensures an adequate and also minimally invasive management of CSP. This treatment protocol is suitable for both CSP types. Another important aspect is the early diagnosis of a pregnancy's localisation especially after a Caesarean delivery should be mandatory in order to prevent CSP morbidity.