Sezaryen Skar Gebeliğinde İntraamniyotik Metotreksat Tedavisi Olgu Sunumu

Öz

Sezaryen skar gebelik insidansı, sezaryen artışına bağlı yükselmekte, konu ile ilgili dünya ve ülkemizde artan bilgi birikimi, skar gebeliklerde tanı, yönetim ve sonuçlar ile ilgili yayınlarla ortaya konulmaktadır. Sezaryen sonrası gebelikler, gebelik kesesinin skara yakınlığına göre: düşükler, morbidite yaratan plasenta adezyon anomalileri plasenta akreta-inkreta, perkreta uterus rüptürü, dissemine intravaskular koagulasyon ve anne ölümleri gibi komplikasyonlarla karşımıza çıkabilmektedir. Nadir görülmesi nedeniyle sezaryen skar gebeliğine dair veriler çoğunlukla olgu sunumlarına dayanır. Bu nedenle tanı ve tedavisi üzerinde fikir birliğine varılmış bir klinik yönetimi bulunmamaktadır. Biz bu çalışmamızda önce gerekli kürü sağlayamayan lokal olarak metotreksat enjeksiyonu tedavisi sonrası sedasyon altında ultrasonografi eşliğinde aspirasyon dilatasyon ve küretaj işlemi ile tedavi olmuş sezaryen yeri skar gebeliğini işleyeceğiz

Anahtar Kelimeler

• Sezaryen skar gebelik, Metotreksat, İntra-amniyotik

A Case Report of Intra-Amniotic Methotrexate Treatment in Cesarean Scar Pregnancy

Öz

The incidence of cesarean section scar pregnancy has increased due to the increase in cesarean, the accumulation of knowledge in the world and our country, and publications on the diagnosis, management and results in scar pregnancies. Pregnancy after cesarean can be complicated by complications such as abortions, miscarriage placenta adhesion anomalies placenta acreta-increta, percreta , uterus rupture, disseminated intravascular coagulation and maternal deaths according to scar proximity. Because of its rarity, cesarean scar pregnancy is mostly based on case reports. There is therefore no clinical management consensus on the diagnosis and treatment. In this study, we will discuss cesarean section scar pregnancy treated with the aspiration dilatation and curettage procedure guided by ultrasonography under sedation after topical methotrexate injection therapy, following initial unsuccessful management

Anahtar Kelimeler

• Cesarean scar pregnancy, Methotrexate, Intra-amniotic

Kaynakça

1. Fylstra DL. Ectopic pregnancy within a cesarean scar: A review. Obstet Gynecol Surv 2002; 57:537-43.
2. 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.
3. 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.
4. Lee CL, Wang CJ, Chao A, Yen CF, Soong YK. Laparoscopic management of an ectopic pregnancy in a previous Caesarean section scar. Hum Reprod 1999; 14:1234-36.
5. Marchiolé P, Gorlero F, de Caro G, Podestà M, Valenzano M. Intramural pregnancy embedded in a previous Cesarean section scar treated conservatively. Ultrasound Obstet Gynecol 2004; 23:307-9.
6. Ofili-Yebovi D, Ben-Nagi J, Sawyer E, Yazbek J, Lee C, Gonzalez J, Jurkovic D. Deficient lower-segment Cesarean section scars: Prevalence and risk factors. Ultrasound Obstet Gynecol 2008;31:72-7.
7. Piccoli V, Martina MD, Biasioli A, Bet E, Driul L, Marchesoni D. Twin ectopic pregnancy in a previous cesarean scar section and subsequent fertility. Eur J Obstet Gynecol Reprod Biol 2008;136:131-2.
8. Pascual MA, Hereter L, Graupera B, Tresserra F, Fernandez-Cid M, Simon M. Three-dimensional power Doppler ultrasound diagnosis and conservative treatment of ectopic pregnancy in a cesarean section scar. Fertil Steril 2007;88:706.

9. Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnancies: Etiology, diagnosis, and management. Obstet Gynecol 2006;107:1373-81.
10. Sugawara J, Senoo M, Chisaka H, Yaegashi N, Okamura K. Successful conservative treatment of a cesarean scar pregnancy with uterine artery embolization. Tohoku J Exp Med 2005;206:261-5.
11. Wang CJ, Yuen LT, Chao AS, Lee CL, Yen CF, Soong YK. Caesarean scar pregnancy successfully treated by operative hysteroscopy and suction curettage. BJOG 2005;112:839.
12. Graesslin O, Dedecker F Jr, Quereux C, Gabriel R. Conservative treatment of ectopic pregnancy in a cesarean scar. Obstet Gynecol 2005;105:869-71.
13. Özcan HÇ, Uğur MG, Balat Ö, Sucu S, Mustafa A, Bayramoğlu Tepe N, Uğur BK. Is ultrasound guided suction curettage a reliable option for treatment of cesarean scar 170 pregnancy? A cross sectional retrospective study. J 171 Matern Fetal Neonatal Med 2017;1:1-6.
14. Ash A, Smith A, Maxwell D. Caesarean scar pregnancy. BJOG 2007;114:253-63.
15. Vial Y, Petignat P, Hohlfeld P. Pregnancy in a cesarean scar. Ultrasound Obstet Gynecol 2000;16:592-3.
16. Yavuzcan A, Başbuğ A, Yıldırım E, Özbilgeç S, Çağlar M. Sezaryen Skar Gebeliğinde Sistemik Metotreksat ve Vajinal Misoprostol Tedavisi: Bir Olgu Sunumu. Jinekoloji - Obstetrik ve Neonatoloji Tıp Dergisi 2017;14(2):89-91.
17. Yin XH, Yang SZ, Wang ZQ, Jia HY, Shi M. Injection of MTX for the treatment of cesarean scar pregnancy: comparison between different methods. Int J Clin Exp Med 2014;7:1867-72.
18. Lam PM, Lo KW, Lau TK. Unsuccessful medical treatment of cesarean scar ectopic pregnancy with systemic methotrexate: A report of two cases. Acta Obstet Gynecol Scand 2004;83:108.
19. 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(1):44.e1-13.