Medical Management of Cesarean Scar Pregnancy
Abstract
Caesarean scar pregnancy (CSP) is an uncommon type of ectopic pregnancy. Here, we aim to present management of our four CSP cases. These cases were enrolled between January 2012 and January 2016. All the patients treated with 50 mg/m intramuscular methotrexate (MTX) injection. After treatment, patients were followed until their serum beta human chorionic gonadotropin (β-hCG) levels reached <5 mIU/mL. All the patients were diagnosed at the first trimester, with the average gestational age of 7 weeks. All patients were cured without surgery. The mean time passed until β-hCG reached <5 mIU/mL was 28 (range, 22-35) days. Only one patient needed second dose MTX. Based on this limited number of case-series experience, it seems that systemic MTX should be the first line treatment for CSP instead of surgery.
Keywords
Ectopic Pregnancy, Caesarean Scar, Methotrexate
Ethical Statement
Internally peer-reviewed.
References
- 1. Roberts H, Kohlenber C, Lanzarone V, et al. Ectopic pregnancy in lower segment uterine scar. Aust NZJ Obstet Gynaecol. 1998;38:114-116.
- 2. Gao L, Huang Z, Zhang X, et al. Reproductive outcomes following cesarean scar pregnancy - a case series and review of the literature, Eur J Obstet Gynecol Reprod Biol. 2016;200:102-107.
- 3. Ngu SF, Cheung VY. Non-tubal ectopic pregnancy. Int J Gynaecol Obstet. 2011;115:295.
- 4. Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnancies:etiology, diagnosis, and management. Obstet Gynecol. 2006;107:1373-1381.
- 5. Marchiolé P, Gorlero F, de Caro G, et al. Intramural pregnancy embedded in a previous Cesarean section scar treated conservatively .Ultrasound Obstet Gynecol. 2004;23:307-309.
- 6. Ash A, Smith A, Maxwell D. Caesarean scar pregnancy. BJOG. 2007;114:253-263.
- 7. Vial Y, Petignat P, Hohlfeld P. Pregnancy in a cesarean scar, Ultrasound Obstet Gynecol. 2000;16:592-593.
- 8. Lan W, Hu D, Li Z, et al. Bilateral uterine artery chemoembolization combined with dilation and curettage for treatment of cesarean scar pregnancy: a method for preserving the uterus. J Obstet Gynaecol Res. 2013;1153-1158.
- 9. Kanat-Pektas M1, Bodur S2, Dundar O, et al. Systematic review: What is the best first-line approach for cesarean section ectopic pregnancy? Taiwan J Obstet Gynecol. 2016;55:263-269.
- 10. Wang Q, Peng HL, He L, et al. Reproductive outcomes after previous cesarean scar pregnancy: follow up of 189 women. Taiwan J Obstet Gynecol. 2015;54:5513.