Cesarean Scar Ectopic Incidence and Management in a Community Hospital Setting: Case Series [9H

Abstract

INTRODUCTION: The rate of Cesarean Deliveries has increased from 20.6% in 1996 to 32.9% in 2009. The incidence of scar ectopic pregnancies has increased reaching an estimated incidence of 1:2226. Objective is to identify the incidence and management of cesarean scar ectopic (CSE) pregnancies in a Community Hospital setting in NY State. METHODS: A retrospective chart review from January 2013 to December 2015 was performed. CSE diagnosed with transvaginal ultrasound. Methotrexate (MTX) single or multi-dose regimen was used. Serial serum human chorionic gonadotropin determinations (bhCG) were obtained until a negative result (< 5 mIU/ml). Descriptive data was analyzed using percentages, means and standard deviations. RESULTS: Five cases of CSE were diagnosed in a 3-year period. Women’s mean age was 34.2 ± 5.6 years. The average gestational age at diagnosis was 56 ± 12.9 days, and number of previous cesarean section was 2 ± 0.7. The mean bhCG at diagnosis was 22,540.2 ± 26,436.9 mIU/ml. Only 1 patient required hysterectomy after MTX due to unfavorable decline on bhCG. The mean duration to reach a negative pregnancy test was 36.7 ± 28.4 days. CONCLUSION: We estimate an incidence of 1 of 36 cases of all ectopic pregnancies diagnosed in the last 3 years and the main treatment used is MTX. Speculation is that this rise may be due to an increase in cesarean deliveries in the recent years and to the type of closure technique performed. Further investigation is encouraged to determine the underlying cause and safest management.