Uterine Artery Embolization to Control Hemorrhage After Termination of Pregnancy Implanted in a Cesarean Delivery Scar

terine scar gestation has been thought to be a rare type of ectopic pregnancy that can lead to catastrophic complications, including considerable maternal morbidity or even death.1 To our knowledge, only 19 cases have been reported in the English language literature in the last 37 years.2 Jurkovic et al3 recently described a series of 18 cesarean delivery scar pregnancies, with a prevalence of 1 per 1800 pregnancies.3 Early sonographic diagnosis allows appropriate treatment to preserve uterine integrity and future fertility. In previously published reports, this condition was treated successfully with intramuscular methotrexate (MTX).4–13 We describe a case of a patient with a cesarean scar pregnancy in whom vaginal bleeding developed after treatment with MTX and who underwent dilation and curettage (D&C) to eliminate residual tissue. When more perfuse bleeding appeared, the patient received blood products, and an emergency angiography was performed. Embolization was performed on both uterine arteries.