Cesarean Scar Pregnancy: A Report of 11 Cases and Review of the Literature Regarding Subsequent Pregnancy

Chiaki Heshiki,Sugiko Oishi,Hitoshi Masamoto,Tadatsugu Kinjo,Kozue Akamine,Yoichi Aoki,Hitoshi Sugiyama,Keiko Mekaru,Maho Miyagi

doi:10.4236/ojog.2016.61002

Abstract

Background: There is no consensus regarding the optimal treatment for cesarean scar pregnancy (CSP) because treatment efficacy, safety, and the influence on subsequent pregnancy must be taken into consideration. Here we report our experience with 11 cases of CSP and review the literature regarding subsequent pregnancy. Methods: Records of 11 CSP cases that were treated at our hospital were retrospectively reviewed. CSP was treated by local methotrexate (MTX) injection or laparotomic or laparoscopic removal of the gestational mass and myometrial repair. Outcome of subsequent pregnancy after treatment was followed-up until delivery. Results: Local MTX injection was performed for six cases, laparotomic removal of the gestational mass and myometrial repair was performed for two, and laparoscopic removal of the gestational mass and myometrial repair was performed for three. The uterus was preserved in all cases. After CSP treatment, eight pregnancies occurred in five cases, resulting in six live births and two miscarriages. Conclusion: Advantages and disadvantages of various treatment methods for CSP continue to be elucidated. Serum hCG level, location of the gestational mass, thickness of the lower uterine segment at the time of diagnosis, and whether the patient wishes for fertility preservation should be considered when choosing a treatment plan.

Highlights

Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy associated with a poor prognosis and a greater risk for uterine rupture and massive genital bleeding with an incidence of one case per 1800 - 2216 pregnancies
Local MTX injection was administered for six cases, laparotomic removal of the gestational mass and myometrial repair was performed for two, and laparoscopic removal of the gestational mass and myometrial repair was performed for three
The postoperative course was good in five cases that were surgically managed, where as two (33%) of six cases that received local MTX injection as a first-line treatment had very high serum hCG levels (28,892 and 34,165 mIU/mL, respectively) and required additional treatment, with one requiring emergency open surgery due to severe bleeding

Summary

Introduction

Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy associated with a poor prognosis and a greater risk for uterine rupture and massive genital bleeding with an incidence of one case per 1800 - 2216 pregnancies. Over our 14 years of experience, we have encountered two cases that required additional treatment because of unfavorable progress after local MTX injection and to preserve fertility for subsequent pregnancies. This experience has led us to reconsider our treatment method. CSP was treated by local methotrexate (MTX) injection or laparotomic or laparoscopic removal of the gestational mass and myometrial repair. Serum hCG level, location of the gestational mass, thickness of the lower uterine segment at the time of diagnosis, and whether the patient wishes for fertility preservation should be considered when choosing a treatment plan

Methods

Results

Conclusion