Abstract
Purpose: This study aimed to highlight the clinical features, diagnosis, and different modalities of the treatment of cesarean scar pregnancy (CSP).Methods: This study was done in the tertiary referral hospital of India for one year. A total of 11 cases were enrolled prospectively. In each case, the diagnostic ultrasonography and measurement of baseline beta-human chorionic gonadotropin (β-HCG) levels were done. The treatment was given based on the hemodynamic status of the patient and desire for future fertility. Various treatment modalities used were medical, surgical, or interventional digital subtraction angiography to control hemorrhage. Also, in some cases, ultrasound-guided methotrexate was injected into the scar ectopic. Medically treated cases were followed up until their β-HCG levels became normal.Results: Out of 11 patients, six had a history of two cesarean sections in the past, four patients had a history of one cesarean section and one patient with a previous three low segments cesarean section (LSCS). Seven out of 11 patients underwent medical management with either methotrexate with potassium chloride (KCl) or methotrexate alone. The success of the medical management was monitored by serial β- HCG values. The mean time for the resolution of these 10 patients was 86.7 ± 53.6 days. Three patients underwent emergency uterine artery embolization due to uncontrolled bleeding and one patient required laparotomy.Conclusion: CSP is a life-threatening condition that can be diagnosed with the help of transvaginal ultrasonography. The treatment, however, depends on the hemodynamic status of the patient and desire for future fertility. Well-defined diagnostic criteria coupled with structured management and follow-up protocol can help in treating this challenging form of ectopic pregnancy.
Highlights
Implantation of the pregnancy within the scar of the previous cesarean section can be a life-threatening condition
We describe the management of patients with Cesarean scar pregnancy (CSP) based on their varied clinical presentations
Transvaginal ultrasonography along with serum β-HCG analysis was used as diagnostic tests for CSP
Summary
Implantation of the pregnancy within the scar of the previous cesarean section can be a life-threatening condition. Cesarean scar pregnancy (CSP) was first described in 1978 by Larsen and Solomon [1]. With the increasing incidence of cesarean deliveries, obstetricians need to be well versed with this rare phenomenon. In CSP, the gestation sac is surrounded by myometrium and the fibrous tissue of the scar [2]. The mechanism of the scar implantation is attributed to the invasion of the myometrium through a microscopic tract between the cesarean section (CS) scar and the endometrial canal [3,4]. The incidence of CSP has been estimated to range from 1/1800 to 1/2500 of all cesarean deliveries performed [5]
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