Objective: To report the first case of caesarean scar pregnancy managed using bilateral uterine artery embolization with methotrexate (MTX) and gelfoam in Malaysia and its outcome, as an alternative non-surgical fertility-sparing method of management.
Method: A 25 year old, G2P1 @ 13 weeks during initial presentation, with a confirmed diagnosis of caesarean scar pregnancy, was initially managed with systemic MTX injections (50mg/m2) – 2 doses given, 6 weeks apart. However, despite reducing levels of serum beta-human chorionic gonadotrophin (HCG), the caesarean scar pregnancy formed a vascular mass with increasing Doppler uptake. Patient was then managed with bilateral uterine artery MTX (50 mg/m2) embolization by interventional radiologist and was followed up monthly with serial transabdominal ultrasound scan and serum beta-HCG.
Result: Serial transabdominal ultrasound scans of this patient over 3 months following uterine artery chemoembolization showed marked reduction in vascularity with reduced Doppler uptake of the caesarean scar pregnancy. However, the size of the caesarean scar pregnancy remained static. No major complications resulting from the uterine artery chemoembolization was observed.
Conclusion: In the event of rare cases of caesarean scar pregnancies, uterine artery chemoembolization seems to be a safe and effective method of treatment and should be considered as one of the options of non-surgical methods of management especially in cases to preserve fertility.