{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T20:30:38Z","timestamp":1790800238862,"version":"4.1.0"},"reference-count":37,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2021,4,23]],"date-time":"2021-04-23T00:00:00Z","timestamp":1619136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy which represents a consequence of a previous cesarean section. It is associated with major maternal morbidity and mortality and has potential implications on future fertility. Because of possible serious complications, CSP should be swiftly diagnosed and treated. There is no management protocol for this rare, life-threatening condition, and each patient should be evaluated individually. Several types of conservative treatment have been used to treat cesarean scar pregnancy: dilation and curettage (D&amp;C), excision of trophoblastic tissues, local or systemic administration of methotrexate, bilateral hypogastric artery ligation, and selective uterine artery embolization with curettage and\/or methotrexate administration. In our study we present a cesarean scar pregnancy of a 40-year-old woman who was treated with angiographic uterine artery embolization (UAE) followed by hysteroscopic diode laser resection. Our combined UAE\u2013hysteroscopic laser surgery appears to offer an effective, safe, and minimally invasive surgical treatment.<\/jats:p>","DOI":"10.3390\/medicina57050411","type":"journal-article","created":{"date-parts":[[2021,4,24]],"date-time":"2021-04-24T21:49:20Z","timestamp":1619300960000},"page":"411","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Cesarean Scar Pregnancy Treated by Artery Embolization Combined with Diode Laser: A Novel Approach for a Rare Disease"],"prefix":"10.3390","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3993-2895","authenticated-orcid":false,"given":"Felice","family":"Sorrentino","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynaecology, University of Foggia, 71121 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"De Feo","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynaecology, University of Foggia, 71121 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9266-3896","authenticated-orcid":false,"given":"Guglielmo","family":"Stabile","sequence":"additional","affiliation":[{"name":"Institute for Maternal and Child Health IRCCS \u201cBurlo Garofolo\u201d, 34100 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5597-3035","authenticated-orcid":false,"given":"Raffaele","family":"Tinelli","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Valle d\u2019Itria Hospital, Martina Franca, 74015 Taranto, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9874-1488","authenticated-orcid":false,"given":"Maurizio Nicola","family":"D\u2019Alterio","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Division of Gynecology and Obstetrics, University of Cagliari, 09042 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8031-1102","authenticated-orcid":false,"given":"Giuseppe","family":"Ricci","sequence":"additional","affiliation":[{"name":"Institute for Maternal and Child Health IRCCS \u201cBurlo Garofolo\u201d, 34100 Trieste, Italy"},{"name":"Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2314-0028","authenticated-orcid":false,"given":"Stefano","family":"Angioni","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Division of Gynecology and Obstetrics, University of Cagliari, 09042 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7184-0822","authenticated-orcid":false,"given":"Luigi","family":"Nappi","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynaecology, University of Foggia, 71121 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,4,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s40738-015-0008-z","article-title":"Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: A review","volume":"1","author":"Panelli","year":"2015","journal-title":"Fertil. Res. Pract."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1002\/uog.974","article-title":"Caesarean scar pregnancy: Issues in management","volume":"23","author":"Seow","year":"2004","journal-title":"Ultrasound Obstet Gynecol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1016\/j.fertnstert.2015.12.130","article-title":"Cesarean scar pregnancy: A systematic review of treatment studies","volume":"105","author":"Petersen","year":"2016","journal-title":"Fertil. Steril."},{"key":"ref_4","first-page":"3186","article-title":"Cesarean scar pregnancy: An analysis of 100 cases","volume":"91","author":"Yu","year":"2011","journal-title":"Zhonghua Yi Xue Za Zhi"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"706.e5","DOI":"10.1016\/j.fertnstert.2006.11.183","article-title":"Three-dimensional power Doppler ultrasound diagnosis and conservative treatment of ectopic pregnancy in a cesarean section scar","volume":"88","author":"Pascual","year":"2007","journal-title":"Fertil. Steril."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1016\/j.jmig.2017.05.019","article-title":"Cesarean Scar Pregnancies: A Systematic Review of Treatment Options","volume":"24","author":"Li","year":"2017","journal-title":"J. Minim Invasive Gynecol."},{"key":"ref_7","first-page":"137","article-title":"Comparative efficacy and safety of local and systemic methotrexate injection in cesarean scar pregnancy","volume":"11","author":"Peng","year":"2015","journal-title":"Ther. Clin. Risk Manag."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.ijgo.2010.11.027","article-title":"Transcatheter arterial chemoembolization versus systemic methotrexate for the management of cesarean scar pregnancy","volume":"113","author":"Li","year":"2011","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1016\/j.fertnstert.2008.07.1780","article-title":"Methotrexate therapy for cesarean section scar pregnancy with and without suction curettage","volume":"92","author":"Wang","year":"2009","journal-title":"Fertil. Steril."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.ejogrb.2014.10.017","article-title":"Successful treatment of endogenous cesarean scar pregnancies with transabdominal ultrasound-guided suction curettage alone","volume":"183","author":"Weilin","year":"2014","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s10397-014-0863-3","article-title":"Transvaginal hysterotomy for cesarean scar pregnancy in 40 consecutive cases","volume":"12","author":"Huanxiao","year":"2015","journal-title":"Gynecol. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1016\/j.fertnstert.2014.01.045","article-title":"Evaluation of the efficacy of laparoscopic resection for the management of exogenous cesarean scar pregnancy","volume":"101","author":"Wang","year":"2014","journal-title":"Fertil. Steril."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e854","DOI":"10.1097\/MD.0000000000000854","article-title":"High-intensity focused ultrasound combined with suction curettage for the treatment of cesarean scar pregnancy","volume":"94","author":"Zhu","year":"2015","journal-title":"Medicine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.1016\/j.jvir.2012.08.013","article-title":"Uterine artery embolization combined with methotrexate in the treatment of cesarean scar pregnancy: Results of a case series and review of the literature","volume":"23","author":"Zhang","year":"2012","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"152.e1","DOI":"10.1016\/j.ajog.2009.04.038","article-title":"Uterine artery embolization compared with methotrexate for the management of pregnancy implanted within a cesarean scar","volume":"201","author":"Zhuang","year":"2009","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1159\/000345503","article-title":"Treatment options to terminate persistent cesarean scar pregnancy","volume":"75","author":"Zhang","year":"2013","journal-title":"Gynecol. Obstet. Investig."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.ijgo.2014.05.005","article-title":"Uterine artery embolization followed by dilation and curettage within 24 hours compared with systemic methotrexate for cesarean scar pregnancy","volume":"127","author":"Gao","year":"2014","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.ijgo.2013.06.029","article-title":"Risk factors for intraoperative hemorrhage at evacuation of a cesarean scar pregnancy following uterine artery embolization","volume":"123","author":"Wang","year":"2013","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"601","DOI":"10.7863\/ultra.34.4.601","article-title":"Cesarean scar pregnancies: Experience of 60 cases","volume":"34","author":"Khatib","year":"2015","journal-title":"J. Ultrasound Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2322","DOI":"10.3760\/cma.j.issn.0366-6999.20140196","article-title":"Uterine artery embolization in cesarean scar pregnancy: Safe and effective intervention","volume":"127","author":"Cao","year":"2014","journal-title":"Chin. Med. J."},{"key":"ref_21","first-page":"1553","article-title":"Laparoscopic Excision of Cesarean Scar Pregnancy with Scar Revision","volume":"27","author":"Yoon","year":"2020","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.1016\/j.fertnstert.2008.12.099","article-title":"Hysteroscopic management of cesarean scar ectopic pregnancy","volume":"93","author":"Deans","year":"2010","journal-title":"Fertil. Steril."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.tjog.2016.06.020","article-title":"The value of hysteroscopic management of cesarean scar pregnancy: A report of 44 cases","volume":"56","author":"Pan","year":"2017","journal-title":"Taiwan J Obstet. Gynecol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.ejogrb.2012.10.013","article-title":"Cervical pregnancy treated by uterine artery embolization combined with office hysteroscopy","volume":"166","author":"Scutiero","year":"2013","journal-title":"Eur. J. Obs. Gynecol. Reprod. Boil."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Stabile, G., Mangino, F.P., Romano, F., Zinicola, G., and Ricci, G. (2020). Ectopic Cervical Pregnancy: Treatment Route. Medicina (Kaunas), 56.","DOI":"10.3390\/medicina56060293"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Stabile, G., Zinicola, G., Romano, F., Buonomo, F., Mangino, F.P., and Ricci, G. (2020). Management of Non-Tubal Ectopic Pregnancies: A Single Center Experience. Diagnostics, 10.","DOI":"10.3390\/diagnostics10090652"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s00404-016-4232-5","article-title":"Feasibility of hysteroscopic endometrial polypectomy using a new dual wavelengths laser system (DWLS): Preliminary results of a pilot study","volume":"295","author":"Nappi","year":"2016","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.ejogrb.2016.08.035","article-title":"Hysteroscopic metroplasty for the septate uterus with diode laser: A pilot study","volume":"206","author":"Nappi","year":"2016","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_29","first-page":"722","article-title":"The use of laser in hysteroscopic surgery","volume":"68","author":"Nappi","year":"2016","journal-title":"Minerva Ginecol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.ejogrb.2019.10.036","article-title":"Ultrasound-guided local methotrexate treatment for cesarean scar pregnancy in the first trimester: 12 years of single-center experience in China","volume":"243","author":"Li","year":"2019","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"102056","DOI":"10.1016\/j.jogoh.2020.102056","article-title":"Cesarean scar pregnancy: Two case report and therapeutic management algorithm","volume":"50","author":"Legris","year":"2021","journal-title":"J. Gynecol. Obstet. Hum. Reprod."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.bpobgyn.2017.09.003","article-title":"Uterine artery embolization: A review of current concepts","volume":"46","author":"Keung","year":"2018","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1590\/S1807-59322011000500016","article-title":"Pregnancy after uterine arterial embolization","volume":"66","author":"Bonduki","year":"2011","journal-title":"Clinics"},{"key":"ref_34","first-page":"266","article-title":"Complications of hysteroscopy: A prospective, multicenter study","volume":"96","author":"Jansen","year":"2000","journal-title":"Obstet. Gynecol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1007\/s00404-020-05885-9","article-title":"Impact of anxiety levels on the perception of pain in patients undergoing office hysteroscopy","volume":"303","author":"Sorrentino","year":"2020","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2138","DOI":"10.18203\/2320-1770.ijrcog20191985","article-title":"Cesarean scar pregnancy: Scope for hysteroscopy","volume":"8","author":"Shah","year":"2019","journal-title":"Int. J. Reprod. Contracept Obstet. Gynecol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1016\/j.tjog.2018.08.013","article-title":"Cesarean scar pregnancy; Diagnosis and management between 2003 and 2015 in a single center","volume":"57","author":"Kim","year":"2018","journal-title":"Taiwan J. Obstet. Gynecol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/5\/411\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:52:08Z","timestamp":1760161928000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/5\/411"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,23]]},"references-count":37,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5]]}},"alternative-id":["medicina57050411"],"URL":"https:\/\/doi.org\/10.3390\/medicina57050411","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,23]]}}}