Uterine scar pregnancy after cesarean section is a rare but dangerous ectopic pregnancy in which the gestational sac is implanted in the uterine scar after cesarean section, also known as uterine incision pregnancy and scar pregnancy. With the increase of cesarean section rate in China, the incidence of this particular ectopic pregnancy has also increased. Seow et al. reported that its incidence was 1/2216, accounting for 6.1% of ectopic pregnancies with a history of cesarean section.2 J. Twelve cases were admitted to our hospital over the past three years, 10 of which were treated with trans-uterine artery MTX perfusion chemo-embolization and forceps, and are reported as follows. DATA AND METHODS 1. GENERAL DATA: The 1O female patients in our group were 22-38 years old, with an average of 29.9 years old. The number of pregnancies was 2-4, with an average of 3.9. The number of labor was 1-2 times. Cesarean section was performed by transverse incision at the lower end of the uterus. The number of cesarean deliveries was 1-2. The current pregnancy was 5 months and 9 years from the previous pregnancy. The preoperative blood HCG value was 440-88470IU/L, and the blood progesterone value was 1.37-30.13 ng/mL. Ultrasound suggested that the myometrium of the anterior wall of the uterus was 0.17-0.70cm thick at the site of pregnancy, and the myometrium of the anterior wall of the other three cases was thin and reached the plasma membrane layer. Methods: l0 patients in this group were treated with the modified Selding technique of right femoral artery puncture and cannulation, and then bilateral uterine arteries were super-selectively cannulated to the superior branches of the uterine arteries. After successful cannulation and confirmation by imaging, antibiotics were first injected into both uterine arteries, and then methotrexate was slowly injected into both uterine arteries, 50mg each, and then gelatin sponge particles (750-11001xm in diameter) were used to embolize the upper uterine arteries. The superior branches of bilateral uterine arteries were embolized, and the tubes were withdrawn after successful embolization and confirmed by angiography, and the postoperative management was routine after the intervention. In the 4-5d postoperative period, clamping was performed under ultrasound supervision, and the scrapings were sent for pathological examination. B-HCG and progesterone values were measured every 3 days after the intervention until the blood B-HCG dropped more than 30% for 2 consecutive times; progesterone dropped to the level of infertility, and then switched to weekly monitoring of blood p-HCG to normal, and continued to be monitored. -HCG to normal, and continue to follow up until the mass disappeared and normal menstruation resumed. 3, results (1) efficacy observation l0 patients are a successful intubation, through the uterine artery MTX perfusion chemotherapy + gelatin sponge embolization, postoperative 3-6d blood B-HCG continuous decline, 2-7w decline to normal, progesterone in the postoperative 3-6d Progesterone decreased to the infertile state in 3-6d postoperatively, menstruation resumed in 25-91d postoperatively, and ultrasound suggested that the pregnancy lesions disappeared in 21-56d. Pregnancy tissue was clamped out under ultrasound supervision in 4-5d postintervention, and intraoperative bleeding ranged from 20-60mL, with an average of 30mL, and postoperative pathology was regression of juvenile placental tissues, and the blood and liver functions were normal. (2) Complications: 10 patients had different degrees of lower abdominal distension and pain, low-grade fever, nausea and vomiting, which were relieved after anti-inflammatory and symptomatic treatments, and 1 patient did not have menstruation after 63d after the operation, and resumed normal menstruation after artificial cycle treatment. 4, Discussion Uterine scar pregnancy is a serious long-term complication after cesarean section, the etiology of which is still unclear. At present, it is generally believed that the cause of this disease is the endometrial damage caused by surgical operations, such as curettage, cesarean section, fibroid removal, hysteroplasty, hysteroscopy and even manual extraction of the placenta Introduction. The principle of treatment is to terminate the pregnancy as early as possible to reduce bleeding and preserve the patient’s reproductive function. Current treatment options include systemic or local MTX medication, hysterectomy, surgical treatment, and uterine artery embolization. Shan Ying et al. analyzed several treatment methods and concluded that uterine artery embolization combined with medication or surgery is a safe and effective option. By summarizing and analyzing the uterine artery embolization treatment of these 10 patients in our hospital, the minimally invasive, safe and feasible nature of this method was also confirmed. Uterine scar pregnancy has the risk of hemorrhage during curettage, in order to reduce hemorrhage and eliminate the harm of hysterectomy, uterine artery perfusion embolization before curettage is the preferred method, which has the following advantages: (1) MTX via uterine artery perfusion allows the drug to enter into the chorionic villous blood vessels directly, and the drug arrives at the lesion with more biologically active free drugs than when given intravenously, and the drug potency can be increased by 2-22 times, thus effectively killing the embryo. The efficacy of the drug can be increased by 2-22 times, thus killing the embryonic tissue effectively and with less side effects. (2) Bilateral uterine artery embolization can quickly stop bleeding and prevent rebleeding, providing patients with uterine scar pregnancy hemorrhage with the opportunity of conservative treatment and eliminating the harm of hysterectomy. (3)It creates the conditions for later clearance of the uterus and makes the bleeding during the clearance operation significantly reduced. (4) Interventional therapy is not limited by the size of the gestational sac and embryonic activity compared to conservative treatment with MTX alone. In this group, there were 2 cases of viable embryos, and after treatment, the blood B-HCG decreased progressively and the pregnancy tissue was successfully removed, so the conservative treatment was successful. (5) Interventional embolization can provide a relatively safe observation period q J for clinical observation of changes in the condition. The experience of embolization operation: (1) The purpose of vascular intervention is to control bleeding and kill the embryo, to prevent bleeding in the clearing operation, and to restore the normal blood supply by restoring the uterine vasculature to the normal blood supply after the removal of the embryo, so gelatin sponge particles were used as an embolization agent during the operation. Gelatin sponge in 2 ~ 3 w can be absorbed by the blood vessels, vascular reopening, it can only embolize to the terminal small arteries, not embolize the precapillary arteries and capillary beds, to ensure that the small capillary arteries plane smooth collateral circulation, so that the uterus can obtain a small amount of nutrient blood supply without ischemic necrosis. (2) As the pregnancy site of uterine scar pregnancy is located in the scar of uterine isthmus, its blood supply mainly comes from the upward branch of uterine artery, so it is best to use microcatheter fine intubation to the upward branch of uterine artery to be embolized. There is no need to go back to the main trunk of the uterine artery for embolization to avoid over embolization, and at the same time, it is also possible to avoid accidental embolization of other branches, such as the ureteric branch of the uterine artery and the bladder branch of the uterine artery, so as to minimize collateral injuries and complications. (3) Intraoperative attention should be paid to the visualization of the ovarian artery to avoid accidental embolization of the ovarian branch of the uterine artery. Although the ovary can be supplied by the ovarian branch of the uterine artery and the ovarian artery, the blood supply of the ovary in a few patients mainly comes from the ovarian branch of the uterine artery, so it is necessary to carefully observe the visualization of the ovarian branch during the operation, and the injection of gelatin sponge particles should be slowly and intermittently under fluoroscopic vision, so as to avoid accidental embolization of the ovarian branch of the uterine artery and thus affecting the function of the ovary. The experience of the operation of the clearance procedure: although the gestational material ischemic necrosis after intervention, but if completely to be its natural absorption and shedding is a long course, because the risk of bleeding after embolization has been greatly reduced, so it is important to choose the right time to perform the clearance in order to remove the gestational material as soon as possible. (1) Timing: after bilateral uterine artery embolization, the lumen of the uterine artery is occluded, which plays the role of hemostasis and prevention of hemorrhage, combined with the efficacy of MTX to kill the embryo reaches its peak within 24h, and the effect is more complete after 3-4d, and the embryo is limited to the mechanization. Therefore, all the patients in this group were cleared in 4-5d after mesothelioma. Postoperative pathological examination of this group of patients was degenerated young placental tissue, confirming that the lesion was ischemic necrosis at this time. (2) Clearing the uterus should be carried out under the supervision of ultrasound: clearing the uterus under the supervision of ultrasound can locate the site of pregnancy and avoid the damage caused by blind clamping. (3) The operation is mainly based on clamping, under the guidance of ultrasound, the pregnancy tissue will be removed by clamping. If the myometrium of the pregnancy site is thin, the tissue is not forced to be cleaned up at one time. After the tissue near the cavity is clamped out, the rest of the tissue is left to be absorbed naturally, thus reducing the risk of uterine damage and perforation. This group of lO patients were successfully implemented clamping surgery, intraoperative bleeding are less, 3d postoperative ultrasound can be seen in the uterine scar a small number of strong echoes, the uterus returned to normal in 2 months after surgery, can be seen in the intermediary of postoperative clearing the official is safe and feasible.