Caesarean Scar Pregnancy: A Single Center Experience

Year 2018, , 26 - 29, 10.03.2018

Alev Özer Abdullah Tok , Bülent Köstü

https://doi.org/10.5799/jcei.413062

Abstract

Objective:
To present the
demographic and clinical characteristics and the treatment method of cases of
caesarean scar pregnancy (CSP).

Patients
and Methods: A
retrospective examination was made of cases diagnosed with CSP at the tertiary
reference hospital of Sütçu Imam University between January 2015 and December
2017. Data were retrieved related to the demographic characteristics of the
patients, ultrasonography (USG) findings and treatment procedures.

Results:
A total of 23
CSP cases were identified in the specified study period. The mean age of the
patients was 31.2 ± 6.9 years, mean gravida was 4.4 ± 1.7, mean gestational age
was 7.0 ± 1.1 weeks and the number of previous caesarean section (CS)
deliveries was 2.0 ± 0.9. Intramuscular methotrexate (MTX) at a dose of 1mg/kg
was applied to all the patients, then after 1 week, a dilatation and curettage
(D&C) procedure. Before the MTX treatment, the initial serum beta-hCG value
was determined as 15813.1 ± 12740.5 IU/mL. The hemoglobin (Hb) level was
determined as 12.3 ± 1.4 before MTX treatment and 11.4 ± 0.6g/dL after the
D&C procedure. Hysterectomy was not applied to any patient. CSP was
determined at the rate of 8.0% of all ectopic pregnancies.

Conclusion:
CSP, which has
shown an increase in recent years in parallel with CS rates, may cause bleeding
and serious complications even as far as maternal mortality. CSP cases in our
clinic were successfully treated with a combination of systemic MTX followed by
D&C.

Keywords

Ectopic pregnancy, caesarean scar pregnancy, methotrexate

References

• 1. Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson CJ. First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment Cesarean section scar. Ultrasound Obstet Gynecol. 2003;21:220-7.
• 2. Timor-Tritsch IE, Monteagudo A, Santos R, Tsymbal T, Pineda G, Arslan AA. The diagnosis, treatment, and follow-up of cesarean scar pregnancy. Am J Obstet Gynecol. 2012;207:44.e1–13.
• 3. Maymon R, Halperin R, Mendlovic S, et al. Ectopic pregnancies in a caesarean scar: review of the medical approach to an iatrogenic complication. Hum Reprod Update. 2004;10:515–23.
• 4. Seow KM, Huang LW, Lin YH, Lin MY, Tsai YL, Hwang JL. Cesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol. 2004;23:247–53.
• 5. Riaz RM, Williams TR, Craig BM, Myers DT. Cesarean scar ectopic pregnancy: imaging features, current treatment options, and clinical outcomes. Abdom Imaging. 2015;40:2589-99.
• 6. Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol 2006;107:1373- 81.
• 7. Birch Petersen K, Hoffmann E, Rifbjerg Larsen C, Nielsen HS. Cesarean scar pregnancy: a systematic review of treatment studies. Fertil Steril. 2016;105:958-67.
• 8. Wang JH, Xu KH, Lin J, Xu JY, Wu RJ. Methotrexate therapy for cesarean section scar pregnancy with and without suction curettage. Fertil Steril. 2009;92:1208–13.
• 9. Sevket O, Keskin S, Ates S, et al. Is methotrexate administration needed for the treatment of caesarean section scar pregnancy in addition to suction curettage? Eur J Contracept Reprod Health Care. 2014;19:128-33.