Abstract
Background. Caesarean scar pregnancy (CSP) is a rare ectopic pregnancy associated with life-threatening complications. To date, no therapeutic protocols have been established. Sono-guided local methotrexate (MTX) injection is a relatively easy and low-invasive treatment. Additional systemic MTX is sometimes needed for CSP cases, especially when β-subunit human chorionic gonadotropin (β-hCG) levels are >20,000 mIU/ml at diagnosis. We report on six cases of CSP treated with local MTX injection, five of which received combined local treatment. Methods. Under intravenous anesthesia, six CSPs including a case with β-hCG levels >20,000 mIU/ml received MTX injection to the gestational sac. Five cases received gestational sac aspiration. Three cases had additional local potassium chloride injection and one case had a saline injection aiming at the fetal heart beat concurrent with MTX injection. MTX was administered weekly if β-hCG levels stayed beyond the expected values. Outcomes. All cases achieved β-hCG normalization without additional systemic MTX, with one case having a successful pregnancy after treatment. Conclusion. Sono-guided local MTX injection with concurrent local treatment might be a potentially effective approach for CSP cases. The accumulation of further cases is necessary to confirm this.
Highlights
Caesarean scar pregnancy (CSP) is an ectopic pregnancy implanted within the uterine scar of a previous caesarean section
We present our experience of six unruptured CSP cases, including one with β-subunit human chorionic gonadotropin (β-hCG) levels higher than
All cases were able to achieve β-hCG normalization without additional systemic MTX administration or surgical treatments
Summary
Caesarean scar pregnancy (CSP) is a rare ectopic pregnancy associated with life-threatening complications. Sono-guided local methotrexate (MTX) injection is a relatively easy and lowinvasive treatment. Additional systemic MTX is sometimes needed for CSP cases, especially when β-subunit human chorionic gonadotropin (β-hCG) levels are >20,000 mIU/ml at diagnosis. We report on six cases of CSP treated with local MTX injection, five of which received combined local treatment. Six CSPs including a case with β-hCG levels >20,000 mIU/ml received MTX injection to the gestational sac. Three cases had additional local potassium chloride injection and one case had a saline injection aiming at the fetal heart beat concurrent with MTX injection. All cases achieved β-hCG normalization without additional systemic MTX, with one case having a successful pregnancy after treatment. Sono-guided local MTX injection with concurrent local treatment might be a potentially effective approach for CSP cases. The accumulation of further cases is necessary to confirm this
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