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

Year 2012, Volume: 39 Issue: 1, 102 - 104, 01.03.2012
https://doi.org/10.5798/diclemedj.0921.2012.01.0104

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.

References

  • Muraji M, Mabuchi S, Hisamoto K, et al. Cesarean scar preg- nancies successfully treated with methotrexate. Acta Obstet Gynecol Scand 2009; 88(6): 720-3.
  • Al-Nazer A, Omar L, Wahba M, Abbas T, Abdulkarim M. Ec- topic intramural pregnancy developing at the site of a cesar- ean section scar: a case report. Cases J 2009; 2(11): 9404.
  • Ash A, Smith A, Maxwell D. Caesarean scar pregnancy. BJOG 2007;114(2):253-63.
  • Tulpin L, Morel O, Malartic C, Barranger E. Conservative management of a Cesarean scar ectopic pregnancy: a case report. Cases J 2009; 2(8): 7794.
  • Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol 2006; 107(10): 1373-81.
  • Abadilla ME, Jaspan D, Dandolu V. Scar pregnancy: a rare complication of caesarean section. Gynecol Surg 2008; 5(2): 253-5.
  • Haimov-Kochman R, Sciaky-Tamir Y, Yanai N, Yagel S. Conservative management of two ectopic pregnancies im- planted in previous uterine scars. Ultrasound Obstet Gyne- col 2002; 19(4): 616-9.
  • Wang JH, Xu KH, Lin J, Xu JY, Wu RJ. Methotrexate ther- apy for cesarean section scar pregnancy with and without suction curettage. Fertil Steril 2009; 92(4): 1208-13.
  • Zhuang Y, Huang L. Uterine artery embolization compared with methotrexate for the management of pregnancy im- planted within a cesarean scar. Am J Obstet Gynecol 2009; 201(2): 152-3.

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

Year 2012, Volume: 39 Issue: 1, 102 - 104, 01.03.2012
https://doi.org/10.5798/diclemedj.0921.2012.01.0104

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.

References

  • Muraji M, Mabuchi S, Hisamoto K, et al. Cesarean scar preg- nancies successfully treated with methotrexate. Acta Obstet Gynecol Scand 2009; 88(6): 720-3.
  • Al-Nazer A, Omar L, Wahba M, Abbas T, Abdulkarim M. Ec- topic intramural pregnancy developing at the site of a cesar- ean section scar: a case report. Cases J 2009; 2(11): 9404.
  • Ash A, Smith A, Maxwell D. Caesarean scar pregnancy. BJOG 2007;114(2):253-63.
  • Tulpin L, Morel O, Malartic C, Barranger E. Conservative management of a Cesarean scar ectopic pregnancy: a case report. Cases J 2009; 2(8): 7794.
  • Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol 2006; 107(10): 1373-81.
  • Abadilla ME, Jaspan D, Dandolu V. Scar pregnancy: a rare complication of caesarean section. Gynecol Surg 2008; 5(2): 253-5.
  • Haimov-Kochman R, Sciaky-Tamir Y, Yanai N, Yagel S. Conservative management of two ectopic pregnancies im- planted in previous uterine scars. Ultrasound Obstet Gyne- col 2002; 19(4): 616-9.
  • Wang JH, Xu KH, Lin J, Xu JY, Wu RJ. Methotrexate ther- apy for cesarean section scar pregnancy with and without suction curettage. Fertil Steril 2009; 92(4): 1208-13.
  • Zhuang Y, Huang L. Uterine artery embolization compared with methotrexate for the management of pregnancy im- planted within a cesarean scar. Am J Obstet Gynecol 2009; 201(2): 152-3.
There are 9 citations in total.

Details

Primary Language Turkish
Journal Section Case Reports
Authors

Deniz Cemgil Arıkan This is me

Emre Turgut This is me

Gürkan Kıran This is me

Hakan Kıran This is me

Publication Date March 1, 2012
Submission Date March 2, 2015
Published in Issue Year 2012 Volume: 39 Issue: 1

Cite

APA Arıkan, D. C., Turgut, E., Kıran, G., Kıran, H. (2012). Cesarean scar pregnancy treated with methotrexate and dilatation-currettage: Case report. Dicle Tıp Dergisi, 39(1), 102-104. https://doi.org/10.5798/diclemedj.0921.2012.01.0104
AMA Arıkan DC, Turgut E, Kıran G, Kıran H. Cesarean scar pregnancy treated with methotrexate and dilatation-currettage: Case report. diclemedj. March 2012;39(1):102-104. doi:10.5798/diclemedj.0921.2012.01.0104
Chicago Arıkan, Deniz Cemgil, Emre Turgut, Gürkan Kıran, and Hakan Kıran. “Cesarean Scar Pregnancy Treated With Methotrexate and Dilatation-Currettage: Case Report”. Dicle Tıp Dergisi 39, no. 1 (March 2012): 102-4. https://doi.org/10.5798/diclemedj.0921.2012.01.0104.
EndNote Arıkan DC, Turgut E, Kıran G, Kıran H (March 1, 2012) Cesarean scar pregnancy treated with methotrexate and dilatation-currettage: Case report. Dicle Tıp Dergisi 39 1 102–104.
IEEE D. C. Arıkan, E. Turgut, G. Kıran, and H. Kıran, “Cesarean scar pregnancy treated with methotrexate and dilatation-currettage: Case report”, diclemedj, vol. 39, no. 1, pp. 102–104, 2012, doi: 10.5798/diclemedj.0921.2012.01.0104.
ISNAD Arıkan, Deniz Cemgil et al. “Cesarean Scar Pregnancy Treated With Methotrexate and Dilatation-Currettage: Case Report”. Dicle Tıp Dergisi 39/1 (March 2012), 102-104. https://doi.org/10.5798/diclemedj.0921.2012.01.0104.
JAMA Arıkan DC, Turgut E, Kıran G, Kıran H. Cesarean scar pregnancy treated with methotrexate and dilatation-currettage: Case report. diclemedj. 2012;39:102–104.
MLA Arıkan, Deniz Cemgil et al. “Cesarean Scar Pregnancy Treated With Methotrexate and Dilatation-Currettage: Case Report”. Dicle Tıp Dergisi, vol. 39, no. 1, 2012, pp. 102-4, doi:10.5798/diclemedj.0921.2012.01.0104.
Vancouver Arıkan DC, Turgut E, Kıran G, Kıran H. Cesarean scar pregnancy treated with methotrexate and dilatation-currettage: Case report. diclemedj. 2012;39(1):102-4.