Hysteroscopic removal of cesarean scar pregnancy after primary therapy with methotrexate: a case series

Abstract

Purpose of Investigation: To present the clinical outcome of cesarean scar pregnancies (CSP) managed by methotrexate (MTX) administration followed by hysteroscopy removal. Materials and Methods: A retrospective study was undertaken in eight consecutive patients admitted to the present Hospital with a diagnosis of CSP, based on ultrasound assessment. The patients underwent systemic (five patients) or local (three patients) MTX administration for pregnancy termination, followed by hysteroscopy removal. A 27Fr resectoscope was used for hysteroscopy surgery. Results: Mean gestational age was of 7.8 weeks and five patients showed a viable embryo. All pregnancies were terminated after MTX; since drug administration, hysteroscopy removal was carried-out after a mean time of 36.1 days. Hysteroscopy view found type 1 and type 2 CSP in one and six patients, respectively. In one patient hysteroscopy assessment demonstrated a cervical pregnancy instead of a type 1 CSP suspected by ultrasound. Mean operating time was of 20.8 minutes, no further intervention was needed, and neither complications were reported. The mean time of menses resumption was of 35.5 days. After the first menstrual period all patients showed β-hCG level in the non-pregnant range and empty uterine cavities. Conclusions: Termination of CSP by MTX, combined with its hysteroscopic removal, resulted to be safe and effective.