Abstract
Introduction: Cesarean scar pregnancy (CSP) is defined as implantation of gestational sac at the site of cesarean scar. It’s a serious diagnosis that has become more prevalent in recent years and related to the increasing rate of cesarean sections reported worldwide. Identifying these cases and treating them is challenging, with no agreed upon universal protocol for successful treatment. We aim to evaluate the success rate and outcome of medical management for Cesarean scar pregnancy. Methods: It was a retrospective descriptive study of all cesarean scar pregnancies managed at fetal medicine unit at Latifa Hospital in Dubai, UAE the main obstetrics & Gynecology tertiary hospital in Dubai Emirate, UAE from 2015 to 2017. Certainly, a set of diagnostic criteria were implemented to confirm the diagnosis of CSP. The cases were then offered our proposed management which is systemic methotrexate injections ± KCL. Follow up made by serial βhcg and ultrasound scan. The data were collected used specified data collection sheet for this purpose then analyzed and presented using statistical package for social sciences (SPSS) version 26. Results: 33 cases of cesarean scar pregnancies are confirmed and medically managed during the study period. The study subjects composed of a group of patients who had a viable CSP and received local KCL injection + systemic methotrexate, a second group who had non-viable CSP and received systemic methotrexate 20 cases were viable pregnancies who received combined local potassium chloride plus systemic methotrexate, and 13 were non-viable received systemic methotrexate only. The mean gestational age at diagnosis was 8 weeks (SD ± 1.8). On average our cases had a history of 3 previous cesarean sections (range 1 - 6). Overall, the success rate calculated from our study population for medical management of CSP was 77.8%; this varied between viable CSP which had a success rate of 66.7% and non-viable CSP which had a success rate of 100%. The average period of outpatient follow-up for the patients to achieve complete resolution was 14 weeks (SD ± 7.5). Conclusions: Medical management of CSP in the form of systemic methotrexate ± local KCL injections proves to have acceptability and a good success rate especially for non-viable CSP, low complications rate and with the benefit of preserving future fertility.
Highlights
Cesarean scar pregnancy (CSP) is defined as implantation of gestational sac at the site of cesarean scar
We aim to evaluate the success rate and outcome of medical management for Cesarean scar pregnancy
On average our cases had a history of 3 previous cesarean sections
Summary
Cesarean scar pregnancy (CSP) is defined as implantation of gestational sac at the site of cesarean scar. It’s a serious diagnosis that has become more prevalent in recent years and related to the increasing rate of cesarean sections reported worldwide. Identifying these cases and treating them is challenging, with no agreed upon universal protocol for successful treatment. Results: 33 cases of cesarean scar pregnancies are confirmed and medically managed during the study period. This number significantly increased to reach more than 1000 cases over the following years This could be due to the increase in numbers of repeated cesarean sections, increased awareness about the morbidities related to this condition and the importance to detect them early so they can be managed more safely with the best possible outcome for the patient. The marked improvement in the quality of the ultrasound imaging played a role in the accurate detection of these cases
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