〔Abstract〕 Objective To investigate the effect of preoperative intraperitoneal injection of methotrexate (MTX) combined with uterine artery embolization (UAE) on blood loss and serum β-human chorionic gonadotropin (β-HCG) conversion in patients with cesarean scar pregnancy (CSP). Methods A total of 150 CSP patients admitted to Shangqiu Maternal and Child Health Hospital from May 2017 to May 2021 were selected and divided into an observation group and a control group by random number table method, with 75 cases in each group. The control group was treated with MTX before intramural injection and uterine clearance, while the observation group was treated with MTX before intramural injection combined with UAE after uterine clearance. The intraoperative blood loss, blood loss 2 h after surgery, blood loss 24 h after surgery, postoperative temperature recovery time, β-HCG negative conversion time, the time of disappearance of adnexal mass and postoperative complications of the two groups were compared. Results The amount of blood loss in the observation group was less than that in the control group during operation, 2 h and 24 h after operation, and the difference was statistically significant (P < 0.05). The temperature recovery time, β-HCG turning negative time and adjunctive mass disappearance time of the observation group were shorter than those of the control group, and the differences were statistically significant (P < 0.05). The incidence of postoperative complications was 14.67% in the observation group and 12.00% in the control group, and there was no significant difference between the two groups (P > 0.05). Conclusion Preoperative MTX combined with UAE can effectively reduce the amount of blood loss in CSP patients, promote the conversion of serum β-HCG to negative, with low complication rate and high safety.