Cesarean scar pregnancy treated with methotrexate and dilatation-currettage: Case report

Abstract

Cesarean scar pregnancy (CSP) is the rarest form of ectopic pregnancies that can cause serious complications. A 37 year-old woman with past history of gravida 4, parity 2, cesarian section, admitted to our outpatient clinic with the complaint of mild pelvic pain and 6 weeks 2 day of amenorrhea. On admission, her serum β-human chorionic gonad-otropin (β-hCG) level was 26905 mIU/mL and transvaginal ultrasound revealed a 24 mm gestational sac implanted at the site of her prior cesarean section scar. Initial treatment with single-dose systemic methotrexate (MTX) (1mg/kg; 60 mg) was not sufficient so the dose of MTX (60 mg) was repeated. In the follow-up the gestational sac continued to increase in size and patient started to feel abdominal discomfort, so we performed an ultrasound-guided dilatation and curettage to obtain complete remission. MTX treatment alone or in conjunction with dilatation-curettage may avoid unnecessary laparotomy, hysterectomy and preserve fertility CSP patients.

Keywords

• Cesarean scar pregnancy, methotrexate, dilatation and curettage

Cesarean scar pregnancy treated with methotrexate and dilatation-currettage: Case report

Abstract

Sezeryan skar gebelikleri ektopik gebeliklerin ciddi komplikasyonlara sebep olabilen en nadir formudur. 37 yaşında, geçmişinde 4 gebelik 4, 2 doğum 2ve bir sezaryen bulunan kadın hasta 6 hafta 2 gündür adet görememe ve hafif pel-vik ağrı şikayetleri ile polikliniğimize başvurdu. Başvuru anında beta- insan koriyonik gonadotropin (β-hCG) değeri 26905 mIU/mL idi ve transvajinal ultrasonografide önceki sezeryan skarına uyan bölgeye yerleşmiş 24 mm boyutun-da gestasyonal kese izlendi. Başlangıçta uygulanan tek doz sistemik metotreksat (MTX) (1mg/kg; 60 mg) tedavisi et-kili olmadığı için MTX (60mg) dozu tekrarlandı. Takipte gestasyonal kesenin boyutları büyümeye devam etti ve hasta karın ağrısı hissetmeye başladı, bu nedenle komplet remisyon amacıyla ultrason eşliğinde dilatasyon ve küretaj işle-mi uyguladık. Sezeryan skar gebeliklerinde MTX tedavisi tek başına veya dilatasyon-küretaj işlemi ile birlikte uygu-landığında, gereksiz laparotomi ve histerektomiyi önleyerek fertiliteyi koruyabilir.

Keywords

• Sezeryan skar gebeliği, metotreksat, dilatasyon-küretaj

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