Objective: To study the application and clinical effect of methotrexate (MTX) cervical pretreatment + hysteroscopy in the treatment of uterine scar pregnancy. Methods: A total of 80 patients with type I uterine scar pregnancy in Hefei Third People’s Hospital from January 2017 to December 2019 were included and divided into two groups according to the random number table method. The control group (n=50) were treated with intervention + hysterectomy, and the study group (n=30) were treated with MTX cervical pretreatment + hysteroscopy. The operation time, intraoperative blood loss, serum β-HCG recovery time and menstrual recovery time of the two groups were recorded and compared, and the clinical treatment effect and the incidence of complications were compared between the two groups. Results: After statistical analysis, the amount of intraoperative bleeding in the study group was significantly reduced after treatment, and the operation time, serum β-HCG recovery time and menstrual recovery time were significantly shortened. Compared with the control group, they had obvious advantages (P<0.05). After statistical analysis, the total effective rate of the research group after treatment was significantly superior to that of the control group (P<0.05). After statistical analysis, the incidence of complications after treatment in the study group was significantly superior to that in the control group (P<0.05). Conclusion: The use of MTX cervical pretreatment + hysteroscopic resection for uterine scar pregnancy has a significant effect, which can reduce the amount of bleeding, improve the treatment effect, speed up the postoperative recovery rate, and reduce the incidence of surgical complications, so the clinical has a positive promotion significance.