Successful management of a spontaneous viable monochorionic diamniotic twin pregnancy on cesarean scar with systemic methotrexate (original) (raw)
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A success of cesarean scar ectopic pregnancy by conservative treatment
IP innovative publication pvt. ltd, 2019
Cesarean scar pregnancy which leads to various complications such as massive uncontrollable bleeding, rupture of uterus resulting in infertility and even hysterectomy is a rare variant of ectopic pregnancy. Cesarean scar pregnancy (CSP) is on a raising trend. The diagnosis and confirmation of CSP is by transvaginal and magnetic resonance imaging (MRI) respectively. Monitoring is by repeated checking of beta hCG values until it falls to non pregnant level and patients are followed-up with USG upto complete resolution of the pregnancy sac is evident. As CSP is very rare there is no exact guidelines for treatment approach. Here we prove that cesarean scar pregnancy can be effectively treated by administration of Methotrexate systemically if the patient comes for regular follow up.
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...
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...
Conservative Management of Cesarean Scar Ectopic Pregnancy: A Case Series
Journal of South Asian Federation of Obstetrics and Gynaecology
Cesarean scar ectopic pregnancy (CSEP) is on the rise with increasing rate of cesarean section and better diagnostic modalities. Therefore, prompt and correct diagnosis and decision about treatment modality are important to reduce mortality and morbidity. Expertise of both gynecologist and radiologist is needed. High index of suspicion should be kept in mind, and any delay in management can lead to detrimental consequences. Here is a case series of three cases with CSEP and their conservative line of management. Diagnosis was made through history,clinical examination, serum beta-human chorionic gonadotropin (β-hCG) levels, ultrasound and hysteroscopy, and confirmed with histopathology also. Methotrexate was the primary treating modality in all the three cases, and the future fertility was preserved. The follow-up was by serum β-hCG and ultrasound scans.
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.
Scar Ectopic Pregnancy - An Emerging Challenge
Cureus, 2021
Cesarean scar ectopic pregnancy (SEP), a rare type of ectopic pregnancy, is the implantation of a gestational sac in the myometrium and fibrous tissues at the site of a previous uterine scar (mostly cesarean section scar). The condition can be catastrophic if not managed on time, leading to significant morbidity and mortality. Early diagnosis made by transvaginal ultrasonography and a high degree of suspicion for the probability of SEP in previous uterine surgery patients may help in the initiation and success of conservative treatment, prevention of complications, and preservation of fertility. We present here the analysis of 22 cases of SEP managed at our institute between 2013 to 2020. The mean gestational age at the time of diagnosis was 8.6±2.2 weeks. The majority of the women presented with either pain or bleeding, but few cases (7 cases) were asymptomatic and were diagnosed with SEP during routine obstetric ultrasonography. Out of these cases, a single case was admitted with shock due to uterine rupture. The mean serum β-hCG level was 29,543 mIU/ml (range, 2105-61590). Asymptomatic patients with low serum β-hCG levels(<15,000 mIU/ml) were given a single dose of methotrexate. Methotrexate was given as a single dose or 4 doses regimen in total 13 cases. Laparotomy with wedge resection of the scar ectopic was done in 8 cases. Overall primary treatment success was recorded in 20 of 22 cases (91%). 2 cases underwent dilatation and curettage due to retained product of conception after primary treatment with methotrexate. The serum β-hCG levels were normalized in an average time period of 53 days. This retrospective case series has proved the role of early and accurate diagnosis of SEP for initiating the treatment in order to minimize maternal morbidity and mortality related to this rare and unusual form of ectopic 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.
Ectopic Pregnancy in Cesarean Section Scar
International Journal of Fertility and Sterility, 2010
Pregnancy implantation within the scar of a previous cesarean delivery is one of the rarest locations for an ectopic pregnancy. Early diagnosis of this condition with the use of ultrasound imaging allows for preserving the uterus and subsequent fertility. However, a delay in either diagnosis or treatment can lead to uterine rupture, hysterectomy and significant maternal morbidity. With increasing incidence of cesarean sections (CS) worldwide and more liberal use of transvaginal sonography (TVS) in early pregnancy, more cases of cesarean scar pregnancy (CSP) are diagnosed. Thus every woman with a previous CS presenting to the early pregnancy unit should have a routine check for the cesarean scar appearance. We present the case of a 34 year-old multigravid woman who was found to have an ectopic pregnancy in a cesarean scar at six weeks gestation, with significantly elevated beta-human chorionic gonadotrophin (Beta-hCG) level.
Cesarean Scar Pregnancy: A Case Series of Diagnosis, Treatment, and Results
Journal of Diagnostic Medical Sonography, 2018
The aim was to collect cases of cesarean scar pregnancy (CSP) and describe the evolution of diagnosis, treatment modalities, and outcome. A retrospective cohort study was conducted of patients who had been diagnosed with CSP. Treatment decision was made according to the type of CSP, levels of beta human chorionic gonadotropin (hCG), and estimated vascularity. Forty cases with CSP were recorded. Overall success of the primary treatment was recorded among 30 of 40 cases (75%) and significantly correlated with degree of vascularity, type of CSP, and beta hCG levels. The treatment methods included serial methotrexate in 20 cases; 15 of them (75%) were successful. In this specific group, we found type 2 scar and high vascularity to be significantly associated with treatment failure. In conclusion, cases with type 2 CSP, high vascularity, and high beta hCG levels should be considered high risk, and extra caution should be taken in choosing treatment modality and follow-up.
SCAR ECTOPIC PREGNANCY: A CASE REPORT
Mariam Ali Alodail, Zahra Ahmed Alhammad, Zahra Wasel Alismail, Amnah Ahmed Alomran, Alhowra Mohammad Albattat
Background: Cesarean section scar ectopic pregnancies are a rare complication of pregnancy that may follow previous hysterotomy for any cause, uterine manipulation, and in vitro fertilization. It has become more common with the increasing cesarean sections as a mode of delivery worldwide. luckily, the use of first- trimester ultrasound imaging has resulted in a significant number of these pregnancies being diagnosed and managed early. Case presentation: We report a case of a 43 years old Saudi female who had three previous cesarean sections and abortion for six times at first trimester which indicated four evacuation and curettage procedures. She presented with mild vaginal bleeding without abdominal pain or other complain. She had no history of contraception use or underlining gynecological illness. Her quantitative serum β-human chorionic β-HCG is 8091 mIU/ml. Transvaginal ultrasound (TVU) showed monochoroinic amniotic gestational sacs, both are non-visible the sacs The ectopic gestation was managed with two doses of methotrexate and one intragestational dose, and then evacuation and curettage was done, and B-HCG levels dropped significantly. Conclusions: Uterine scar ectopic pregnancies are a diagnostic challenge that require a high level of suspicion during clinical imaging and follow-up. A missed diagnosis with delayed management may lead to uterine rupture, severe hemorrhage, and maternal death. Keywords: cesarean scar ectopic pregnancy, Diagnostic challenge, management.