Abstract
Objective Implantation of the pregnancy in a cesarean scar is a rare condition named ; Cesarean scar pregnancy (CSP). Maternal complications can be prevented with the early diagnosis and an appropriate management .It is a Prospective clinical study to evaluate the efficacy and success rate of single dose use of methotrexate (MTX) followed by dilation and suction (D&S) regimen in management of women with cesarean scar pregnancy (CSP) . Methods 50mg of MTX in the form of a single dose Intramuscular injection then cervical dilatation and suction aspiration with a Karman cannula(D&S) under guidance of ultrasound after 48 preeceeded by vaginal misoprostol 2 tablet (200 mg) 4 hours ago. Results The mean gestational age at diagnosis was (8.5±1.6 ) and The mean level of serum b-human chorionic gonadotropin was (7424±2.560 ) and The mean gestational age of pregnancy was (8.5±1.6 ) .88.7% is the successive rate without complication need intervention, 2 (5.7%) patients needed intrauterine Foley's catheter for 24 hours as a mechanical hemostasis . 2 (5.7 %) had laparotomy with wedge resection of the gestational sac lesion and successful repair of the uterine defect and one (2.8 %)underwent subtotal hysterectomy. Conclusion: Systemic single dose MTX injection followed by D&S is an effective and harmless management for CSP. Nevertheless more studies are required to prove the efficiency, safety, and reproductive outcome of variant modalities in treatment of CSP.
Highlights
Increase the incidence caesarean delivery lead to attendance of one serious complication which is Cesarean scar pregnancy (CSP) is a uncommon form of ectopic pregnancy In which the gestational sac is imbedded in a cesarean scar of the lower uterine segment.[ 1]CSP is a risky condition, probably leading to immense bleeding uterine rupture, and life-threatening complications[2].The accurate incidence of CSP is unidentified
The mean gestational age at diagnosis was (8.5±1.6 ) and The mean level of serum b-human chorionic gonadotropin was (7424±2.560 ) and The mean gestational age of pregnancy was (8.5±1.6 ) .88.7% is the successive rate without complication need intervention, 2 (5.7%) patients needed intrauterine Foley's catheter for 24 hours as a mechanical hemostasis . 2 (5.7 %) had laparotomy with wedge resection of the gestational sac lesion and successful repair of the uterine defect and one (2.8 %)underwent subtotalhysterectomy
Systemic single dose MTX injection followed by dilatation and suction (D&S) is an effective and harmless management for CSP
Summary
Increase the incidence caesarean delivery lead to attendance of one serious complication which is Cesarean scar pregnancy (CSP) is a uncommon form of ectopic pregnancy In which the gestational sac is imbedded in a cesarean scar of the lower uterine segment.[ 1]CSP is a risky condition, probably leading to immense bleeding uterine rupture, , and life-threatening complications[2].The accurate incidence of CSP is unidentified. Serial serum human chorionic gonadotropin (HCG) measurements and transvaginal ultrasound examination, mainly in pregnant woman with a previous cesarean delivery early in pregnancy are necessary for early diagnosis and termination of that pregnancy .[6] magnetic resonance imaging (MRI), and endoscopic modalities may be helpful for diagnosis and the management of(CSP)7 It is frequently required for cases in which the TVUS is not definite or did not obviously prove urinary bladder Envelopment [ 7] To decrease the threat of a false diagnosis and improve its accuracy, a collective ultrasound ( TVS, TAS, color flow Doppler, and three-dimensional TVS ) should be suggested [ 8]The modalities of treatment are whichever medical , surgical or combined. Its use alone needs an extended time to follow-up both beta-hCG to return to normal and gestational mass to resolve [12] some studies proved that CSP responded well to the single dose of Systemic MTX 50 mg/m2
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