Successful local and systemic medical treatment of cesarean scar pregnancy and a subsequent term pregnancy after treatment: a case series (original) (raw)
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Cesarean scar pregnancy treatment: a case series
Journal of Medical Case Reports
Background Cesarean scar pregnancy is a complicated and potentially life-threatening type of ectopic pregnancy. This study reports two women with cesarean scar pregnancy who were successfully treated with systemic methotrexate administration, and two other women who needed local re-administration of methotrexate after systemic injection. Case presentation Four Iranian pregnant women aged 29–34 years who were between 5 to 7 gestational weeks with cesarean scar pregnancy diagnosis are described. After a single dose of systemic methotrexate injection, the level of serum beta-human chorionic gonadotropin decreased in two of the women, while fetal activity was observed in the other two women. In the latter patients, methotrexate was injected under transvaginal ultrasound guidance into the gestational sac. As a result, the serum beta-human chorionic gonadotropin level first increased and then decreased in these patients. During the follow-up period, all the patients were stable and no co...
Human Reproduction Open, 2020
STUDY QUESTION Is exclusive use of intragestational sac potassium chloride (KCl) and methotrexate (MTX) effective in the management of viable cesarean scar pregnancy (CSP)? SUMMARY ANSWER Exclusive use of intragestational sac KCl and MTX was effective in the management of viable CSP. WHAT IS KNOWN ALREADY Owing to a paucity of randomized studies on management of CSP, evidence-based management remains unclear. Intragestational sac KCl or MTX along with either systemic MTX or surgical intervention, such as uterine artery embolization or dilation and curettage, has proved to be effective in the management of CSP. Furthermore, there are limited data in the literature on the use of exclusive intragestational sac KCl and MTX for management of CSP and subsequent fecundity. STUDY DESIGN, SIZE, DURATION A prospective cohort study was conducted from June 2017 to September 2019. We recruited nine CSP patients referred to our unit. There was no lost to follow-up noted. PARTICIPANTS/MATERIALS, S...
Archives of Gynecology and Obstetrics, 2009
To present a case of an ectopic pregnancy in a previous caesarean scar in a woman who wishes to preserve her fertility, and its treatment with the local administration of potassium chloride (KCl) and methotrexate (MTX) via a transvaginal needle. A 35-year-old woman with a viable caesarean scar pregnancy was referred to our hospital. After an unsuccessful treatment attempt by administering 60 mg systemic methotrexate, the patient was treated with local administration of KCl and MTX using a transvaginal needle. The persistent ectopic mass was removed with dilatation and curettage (D&C) 1 week later. The patient had no complications and the treatment was successful in the follow-up examinations. Local MTX and KCl treatment using a transvaginal needle together with D&C can avoid unnecessary laparotomy, and helps to preserve the fertility of most women with a caesarean scar pregnancy.
Successful Surgical and Medical Management of Cesarean Scar Pregnancy in 2 Patients
Journal of Gynecologic Surgery, 2014
Background: Cesarean scar pregnancy (CSP), once a rare entity, is on the rise due because of an increase in the cesarean section rate worldwide. Currently, there is no standard protocol available for managing CSP. To contribute to the existing literature, this article presents the current authors' experience with 2 cases of CSP that were treated successfully with two different modalities. Cases: Case 1: A 34-year-old, gravida 2, para 1, was diagnosed with a CSP on initial transvaginal ultrasound (TVUS) scan at 6 weeks of gestation. Aspiration of the gestational sac and a local injection of methotrexate was performed. After 2 weeks, the gestational sac increased in size with thinning of the CS scar (1 mm), and plateauing of the ß-human chorionic gonadotropin (ß-hCG) occurred. Laparoscopic excision of the CSP and myometrial repair resulted in resolution. Case 2: A 31-year-old, gravida 3, para 1, achieved pregnancy after a frozen-thawed embryo transfer cycle. A TVUS scan, performed at 6 weeks of gestation showed a CSP. The patient's ß-hCG level was 310 mIU/mL. Systemic methotrexate was administered intramuscularly. The patient's ß-hCG on days 4 and 7 was 260 and 252, respectively. A repeat TVUS on day 7 showed a resolving gestational sac. A second dose of methotrexate resulted in complete resolution of the CSP. Results: The treatments (aspiration, methotrexate, and laparoscopic excision for Case 1, and methotrexate for Case 2) enabled resolution of the CSPs of these 2 patients. Conclusions: Various treatment modalities have been described for managing CSP with varied levels of success. When local injection of methotrexate into the gestational sac of CSP is unsuccessful, laparoscopic removal is safe and effective. Moreover, in the presence of low levels of b-hCG, treatment with systemic methotrexate is usually successful.
Ochsner Journal, 2020
Background: Cesarean scar pregnancy is a rare, potentially life-threatening complication in patients with prior cesarean delivery. Vaginal bleeding is a common presenting symptom. Case Report: A 23-year-old female who presented with mild vaginal bleeding was diagnosed by transvaginal ultrasound with a viable cesarean scar pregnancy of 7 weeks' gestation. After the sac content was suctioned through a transvaginal approach under ultrasound guidance, the patient was injected with 50 mg local and 25 mg systemic methotrexate. One week later, a repeat systemic methotrexate dose of 50 mg was administered. The patient's beta human chorionic gonadotropin (hCG) levels were followed weekly until a negative beta hCG level was established. Conclusion: No management approach has been universally approved for cesarean scar pregnancy; the best option depends on case presentation, surgeon experience, and available facilities. We suggest that our minimally invasive treatment is an acceptable approach, especially if embryonic cardiac activity is present. We recommend the referral of such cases to tertiary centers to avoid complications.
Cesarean Scar Pregnancy Managed with Conservative Treatment
Iranian journal of medical sciences, 2016
Cesarean scar pregnancy (CSP) is a rare, but life-threatening type of ectopic pregnancy. An exact and early diagnosis of CSP is very important for prognosis. The aim of the present study was to describe 4 women with CSP and discuss their clinical presentations, diagnoses, and various management options along with the published literature. Four women with a suspicion of CSP or cervical pregnancy were referred to our hospital between August 2013 and January 2014. All the patients were counseled about medical management options. After the treatment, serum beta human chorionic gonadotropin (ß-hCG) levels were followed weekly until they reached <5 mIU/mL. All the patients were diagnosed at the first trimester, with the average gestational age of 6.4±0.9 weeks. Treatment was systemic methotrexate (MTX) treatment in 3 of the 4 women, requiring no further intervention. The remaining 1 woman was treated with an intragestational administration of MTX. The mean time passed until ß-hCG reach...
Ineffectual Medical Treatment of Cesarean Scar Ectopic Pregnancy With Systemic Methotrexate
Journal of Investigative Medicine High Impact Case Reports, 2014
The implantation of a pregnancy within the scar of a previous cesarean section is known as a “cesarean scar pregnancy.” Its incidence was reported to be 6.1%. However, with the increasing rates of cesarean sections, the incidence is expected to rise. A variety of conservative and surgical treatment modalities have been proposed for the management of cesarean scar pregnancy; however, there are no optimal universal treatment guidelines because of its rarity. Treatment should be tailored to the individual patient. It is obvious that more scar pregnancies will be seen in the future and therefore a set of criteria for the choice of various modes of management should be developed. Here, we present 2 cases of cesarean scar pregnancies treated with a local injection of potassium chloride after the failure of methotrexate administration.
Outcome of cesarean scar pregnancy treated with local methotrexate injection
Nagoya Journal of Medical Science, 2020
Local injection of methotrexate (MTX) has been widely used for caesarean scar pregnancy (CSP), but the optimal candidate remains undetermined. The aim of this study is to determine the risk factors associated with treatment failure among patients who received a single dose of local MTX. This is a retrospective cohort study. Clinical information was compared between treatment success vs. failure groups. Risk factors related to treatment failure were also investigated with multivariate analysis. Of 47 patients diagnosed with CSP, 30 received local MTX injection. The initial serum ß- human chorionic gonadotropin (hCG) level in the failure group was significantly higher than in the success group (p = 0.048), and the cut-off value was 47,000 mIU/ml. The rate of type 2 position of the gestational sac in the failure group was significantly higher than in the treatment success group (p = 0.031). A high initial serum ß-hCG level (≥ 47,000 mIU/ml) was identified as the independent risk factor...
2021
Background: Caesarean Scar Pregnancy (CSP) is a very rare form of an abnormal pregnancy that implants in a Cesarean section scar. The incidence is mainly increasing due to increasing number of Cesarean sections. This condition is associated with substantial morbidity and even mortality. Case presentation: Because of its rarity, currently, there is no consensus on the preferred mode of treatment or follow up of CSP. Herein we report our experience with a case of first trimester CSP which was successfully managed with dilatation, evacuation and curettage (D&C), under ultrasound guidance, after failed local Methotrexate (MTX) treatment. Mini review: We included an updated mini review of literature targeted for such lines of treatment (local MTX and D&C). The first authoritative recommendations on the CSP, by the Society for MaternalFetal Medicine, are summarized. Conclusion: Operative intervention as D&C to treat CSP after failed local MTX treatment is a viable option characterized by ...
Gynecology and Minimally Invasive Therapy, 2019
IntroductIon Cesarean section scar pregnancy (CSSP) is an intrauterine pregnancy that occurs following implantation of the gestational sac over the previous uterine scars. [1] Previous uterine scar is the only risk factor for CSSP. The true incidence of CSSP estimated as 1/1800-1/2500 of all cesarean deliveries, [1] and the incidence of CSSP increased due to increased rate of cesarean deliveries and improved imaging tools. [2] The CSSP is often misdiagnosed as inevitable miscarriage or ectopic pregnancy. [3] This report highlights the successful outcome immediately after the proper management of CSSP cases. caSe rePort A 27-year-old CSSP case diagnosed by the vaginal ultrasound which showed gestational sac located in the lower uterine anterior quadrant close to the site of the previous scars (with yolk sac inside) with β-hCG 15373 mIU/ml in September 2017 was managed by intramuscular (IM) multi-dose methotrexate (MTX). IM-MTX injection was alternating with leucovorin (active form of folic acid). She was followed up by the β-hCG, vaginal ultrasound, and hematological parameters. The studied woman discharged home when the β-hCG decreased to 11,630 on the 1 st week after the first MTX dose. A 27-year-old cesarean section scar pregnancy (CSSP) case diagnosed by the vaginal ultrasound which showed gestational sac located in the lower uterine anterior quadrant close to the site of the previous scars (with yolk sac inside) with β-hCG 15,373 mIU/ml in September 2017 was managed by intramuscular (IM) multidose methotrexate (MTX). The studied woman discharged home when the β-hCG decreased to 11,630 mIU/ml on the 1 st week after the first MTX dose. On the 5 th week after the first dose of IM-MTX, the β-hCG dropped to zero and the gestational sac completely disappeared. She was counseled about the risk of pregnancy in the first 6 months after the MTX and the possibility of the CSSP recurrence. She presented on December 16, 2018, with preterm delivery at 35 weeks' gestation. After delivery, her neonate admitted to the neonatal intensive care unit (NICU) due to mild respiratory distress and discharged from the NICU on the 4 th day in good condition. Multi-dose MTX regimen for the treatment of CSSP supported by many authors with follow-up by β-hCG and vaginal ultrasound. This report highlights the successful outcome immediately after the proper management of CSSP cases.