Abstract: Objective：To evaluate the effect and the best administration of suction curettage under ultrasound guidance after methotrexate (MTX) treatment combined uterine artery embolization(UAE) for cesarean scar pregnancy (CSP). Methods：This was a retrospective case study of 51 cases who were diagnosed as CSP and treated by suction curettage under transabdominal ultrasound guidance after MTX treatment combined uterine artery embolization as an initial treatment of CSP in Chaoyang Hospital, Capital Medical University from January 2011 to December 2014. 51 patients were divided into three groups. Group A (23 cases): MTX systemic administration followed by UAE, and then fixed-point suction surgery. Group B (11 cases): Uterine arterial chemoembolization (UACE) followed by fixed-point suction surgery. Group C (17 cases): MTX systemic administration combined with UACE, and then fixed-point suction surgery. The basic information, the situation before treatment, intraoperative situation and assessment of therapeutic effect indicators of each group of patients were compared. Results：The three groups of patients were all one-time successful operation, with no secondary processing such as laparoscopic surgery. There was no case of bladder injury, uterus perforation and hysterectomy. The three groups in operation time, intraoperative blood loss, β-hCG to normal time, lesion absorption time, the success rate and the incidence of complications had no statistical significance (both P＞0.05). The hospitalization time and expenses in group B compared with the other two groups were decreased significantly (both P＜0.05). The maximum diameter of gestational sac or mass in Logistic regression model was statistically significant (OR=1.094, 95%CI: 1.012-1.183, P=0.024). Conclusions：Suction curettage under transabdominal ultrasound guidance after MTX treatment combined uterine artery embolization is safe and effect. It can be widely used in the treatment of endogenous and exogenous CSP. UACE is recommended as the preferred method for preoperative pretreatment. It is more security for patients whose lesions biggest diameter is less than 4.3 cm.

Key words: Pregnancy, ectopic, Cesarean section, Cicatrix, Uterine artery embolization, Dilatation and curettage