Cases Of Cesarean Scar Pregnancy Research Articles

Case Series: Medical Versus Surgical Management of Cesarean Scar Pregnancy [ID 2683419

INTRODUCTION: Although cesarean scar pregnancy (CSP) is rare, it is a potentially fatal condition, and the incidence is rising. Treatment of CSP may consist of medical management with methotrexate or surgical management; however, a consensus regarding optimal treatment has not been well defined. This series reports our experience with management of CSP. METHODS: Our series included a chart review that identified 10 cases of CSP from 2020 to 2023 at a high-volume, community-based, academic hospital that serves as a surgical referral center in a metropolitan area. We obtained IRB exemption. RESULTS: At diagnosis of CSP, gestational age by ultrasound ranged from 5 6/7 weeks to 11 4/7 weeks. None of the pregnancies had ruptured. Eight cases reported symptoms including bleeding or abdominal pain. Six underwent surgical management: one dilation and evacuation (D&E), one D&E converted to laparotomy, two combined D&Es with robotic-assisted laparoscopic excisions, and two laparotomies with excision. Four received methotrexate: one intragestational, two dual-dose intramuscular, and one single-dose intramuscular. All surgical cases resulted in definitive resolution. Of those treated with methotrexate, three of four cases required additional methotrexate treatment. Time from initial dose of methotrexate to resolution ranged from 29 to 95 days. CONCLUSION: In our experience, the advancement of gynecologic surgical modalities has broadened options for CSP treatment to allow for definitive and timely management. Methotrexate remains a viable option; however, treatment failures occur and may prolong a potentially life-threatening condition. Our findings strengthen the recommendation for surgical management, consistent with SMFM guidelines. Furthermore, there is an opportunity to provide surgical training to better equip gynecologists with the ability to treat this challenging condition.

Cesarean Scar Ectopic Pregnancy: Experience From Benghazi Medical Center, 2022

Background: Cesarean scar pregnancy (CSP) is a rare consequence of a previous cesarean delivery and a new type of ectopic pregnancy, but it is life-threatening if unrecognized and inadequately managed. Despite the rising incidence of CSP, there are no consensus or evidence-based guidelines for management. Aims: To review risk factors, clinical features, diagnostic methods, and management of women with CSP at Benghazi Medical Center. Materials and methods: A descriptive-case series study of CSP cases between the Ist of March 2018 and Ist of April 2022.. Data collected retrospectively. The data included demographics, presenting symptoms and signs, ultrasound findings, treatment used, and any complications. Results: The total number of ectopic pregnancies in period between 1st March 2018 and 1st April 2022 was 262, ten women (3.82%) were diagnosed as scar ectopic, The women's ages ranged from 28 to 47 years, about 60% had three or four previous cesarean scars, abdominal pain with vaginal bleeding was in 30% of the cases, while 60% of patients were asymptomatic and all patients were stable during the diagnosis, except for one case that had signs of shock. ultrasound finding was 80% presence of gestational sac implanted low near the previous scar; initial diagnosis was delayed by 50%. The management was laparotomy and gestational sac excision in four cases that did not require further treatment, dilatation and uterine evacuation were done in two cases that required use of uterine balloon to control bleeding and further use of methotrexate In one case (10%), systemic methotrexate alone was effective. Severe bleeding was seen among 60% of women, and 20% underwent hysterectomy. The complications were significantly (P< 0.05) more common among women with high parity and also in cases where there was no intervention during the diagnosis. Conclusion: A previous uterine scar is the main risk factor for CSP; there is no specific clinical feature for CSP; ultrasound is used for the diagnosis; surgical management appears to be a better option, serious complications were seen mainly when no intervention was done during the diagnosis.

Ruptured Cesarean Scar Pregnancy: A Case Report

Ectopic pregnancy is defined as implantation outside the uterine cavity with an incidence rate of 19 per 1000 conceptions in the United States, accounting for >64,400 hospitalizations annually. It is the leading cause of maternal death in the first trimester. Most ectopic pregnancies (98%) occur in the fallopian tube but can also occur elsewhere. Cesarean scar pregnancy is a form of ectopic implantation in the fibrous tissue around the scar of previous cesarean delivery. The first case of cesarean scar pregnancy was described by Larsen and Solomon in 1978, and only 19 cases were reported until 2001. 3 The incidence of cesarean scar pregnancy is estimated to be 1:1800 to 1:2216 pregnancies. This condition represents 6.1% of all ectopic pregnancies with a history of at least one cesarean operation. In Indonesia, this case is rarely reported, and there is no data on the prevalence of this disease in Indonesia. Due to its rarity, we report a case of a 37-year-old G2P0100 woman with ruptured cesarean scar pregnancy.

Cesarean Scar Pregnancy: A Tertiary Care Center Experience

Objectives: To describe the management and treatment outcomes of cesarean scar pregnancies diagnosed in a tertiary care center. Methods: This study retrospectively described all cases of cesarean scar pregnancy diagnosed and managed at a tertiary care center over a 3-year period. Maternal demographics, clinical presentation, treatment methods, and outcomes were all included in the analysis. Results: uring the study period, 5 cases of cesarean scar pregnancy were diagnosed and managed. The median gestational age at diagnosis was 8 weeks, and all fetuses had positive cardiac activity. All cases were initially treated with systemic intramuscular (IM) methotrexate (MTX), but only one case responded well due to fetal bradycardia present prior to treatment. One patient received further management with transvaginal intracardiac potassium chloride (KCL) injection, which resulted in maternal sepsis, hemorrhage, and ICU admission. The other 3 cases were managed by transabdominal intra-gestational sac MTX +/- KCL and showed good clinical response. Two of these cases required an interval dilation & curettage (D&C) due to persistent vaginal spotting with no complications. Conclusions: It is recommended to avoid using systemic IM MTX as the first-line treatment for scar pregnancy unless the pregnancy is failing or non-viable. Intra-gestational sac treatment may cause persistent retained products of conception, leading to bothersome vaginal spotting. An interval ultrasound guided D&C appears to be safe for managing this complication, but the exact interval needs to be determined through further studies. Sepsis is a rare complication of invasive medical treatment, and close surveillance is advised.

Comparing the clinical efficacy of three surgical methods for cesarean scar pregnancy

BackgroundWe aimed to compare the clinical efficacy of three surgical methods in the treatment of various types of cesarean scar pregnancy (CSP).MethodsHerein, 314 cases of CSP were treated in the department of Obstetrics and Gynecology of the First Affiliated Hospital of Gannan Medical University between June 2017 and June 2020. The patients were divided into three groups based on the treatment received: group A (n = 146; curettage by pituitrin combined with ultrasonic monitoring and hysteroscopy-guided surgery), group B [n = 90; curettage after methotrexate (MTX) injection into the local gestational sac], and group C (n = 78; laparoscopic, transvaginal, and transabdominal cesarean scar resection). These groups were divided into three subgroups (type I, type II, and type III) according to the CSP type of the patients.ResultsThe intraoperative blood loss, length of hospital stay, hospitalization cost, menstrual recovery time, and serum β-HCG normalization time were lower in groups A than in groups B or C with type I, II and III CSP (P < 0.05). Operative efficiency and Successful second pregnancy rate were higher in groups A than in groups B or C with type I and II CSP (P < 0.05). But in type III CSP, the complications were more serious in group A than group C.ConclusionsCurettage by pituitrin combined with ultrasonic monitoring and hysteroscopy-guided surgery is an effective and relatively safe treatment for patients with type I and II CSP. Laparoscopic surgery is more suitable for type III CSP.

Cesarean Scar Pregnancy: A Case Report

Introduction: A relatively new type of ectopic pregnancy is cesarean scar pregnancy (CSP). This is related to the increasing number of cesarean deliveries and to the advances in imaging. There are 2 types of CSP; CSP with progression to cervicoisthmic space or uterine cavity (type I, endogenic type) or with deep invasion of scar defect with progression towards bladder and abdominal cavity (type II, exogenic type). The endogenic type of CSP could result in a viable pregnancy; yet with a high risk of bleeding at the placental site. The exogenic type could be complicated with uterine rupture and bleeding early in pregnancy. As early diagnosis and treatment is important for the best outcome, every pregnant woman with history of cesarean delivery should be screened early in the first trimester of pregnancy. Diagnosis can be achieved with ultrasound and Doppler imaging. To date there have been only 5 randomized studies on CSP and evidence based management remains unclear. Until then, treatment should be individualized according to many factors including clinical presentation, β-hCG levels, imaging features, and the surgeon’s skill. We report a case of cesarean scar pregnancy successfully managed in our university hospital center.

Management of cesarean scar pregnancy: Importance of gestational age at diagnosis and disease type-A single center's 5 years of experience involving 223 cases.

This study aims to evaluate the importance of the gestational age at diagnosis and the types of cesarean scar pregnancy (CSP) for treatment outcomes and to identify the optimal treatment based on both the gestational age at diagnosis and the CSP type. A retrospective cohort study included 223 pregnant women diagnosed with CSP at Peking University First Hospital, Beijing, China, between 2014 and 2018. All CSP cases underwent ultrasound-guided vacuum aspiration followed by supplementary curettage. Adjuvant treatment modalities included intramuscular injection of systemic methotrexate, uterine artery embolization, and hysteroscopy before ultrasound-guided vacuum aspiration. Linear regression was used to determine the relationship between intraoperative blood loss and gestational age at diagnosis, CSP type, highest β-human chorionic gonadotropin level, and management procedures. None of the patients required blood transfusions or hysterectomies. Patients presenting at <8, 8-10, and >10 weeks had median estimated blood loss of 5, 10, and 35 ml, respectively. Patients with type I CSP, type II CSP, and type III CSP had median blood loss of 5, 5 and 10 ml, respectively. Multivariate linear regression analysis demonstrated that the gestational age at diagnosis (p < 0.001) and type of CSP (p = 0.023) were independent predictors of intraoperative estimated blood loss. For type I CSP patients, ultrasound-guided vacuum aspiration followed by supplementary curettage alone was performed in 15 of 34 (44.1%) patients, including 12/27 (44.4%) diagnosed at <8 weeks, 2/6 (33.3%) at 8-10 weeks, and 1/1 for >10 weeks. In type II CSP patients, fewer cases were managed by ultrasound-guided vacuum aspiration followed by supplementary curettage alone as the gestational age at diagnosis increased [18/96 (18.8%) for <8 weeks, 7/41 (17.1%) for 8-10 weeks, none for >10 weeks]. Most type III CSP patients (41/45, 91.1%) needed treatments in addition to the ultrasound-guided vacuum aspiration regardless of the gestational age at diagnosis. All CSP patients were treated successfully and did not require readmission or further medical interventions. Gestational age at diagnosis of CSP and its type show a strong correlation with estimated blood loss during ultrasound-guided vacuum aspiration. With careful management, CSPs may be treated at any gestational week, regardless of their type, with minimal intraoperative bleeding.

Scope and Suction: Hysteroscopic-guided Suction Evacuation of Cesarean Scar Pregnancy - A Safe and Efficacious Treatment for Selected Patients.

This study aimed to evaluate hysteroscopic-guided suction evacuation for the treatment of cesarean scar pregnancy (CSP). This was a retrospective analysis of CSP over 2 years. This study was conducted at KK Women's and Children's Hospital (KKH), Singapore, thirty-seven patients with a CSP. Hysteroscopic-guided suction evacuation to treat CSP used alone or in combination with laparoscopy depending on residual myometrial thickness (RMT) and future fertility requirements. The majority of women (29) were diagnosed under 9-week gestation. Just over a third (13) had an RMT of more than 3 mm. Women with an RMT <3 mm had added laparoscopy. In total, 22 women had hysteroscopic-guided suction evacuation with 9 having it performed under laparoscopic guidance because the RMT was under 3 mm. The remaining patients underwent either laparoscopic repair (5 cases) or vaginal repair (1 case) done under laparoscopic guidance. Hysteroscopic-guided suction evacuation of CSP has the potential to become part of the routine management for uncomplicated cases of CSP in women with an RMT of greater than 3 mm who do not wish for future pregnancy. Its use, in combination with other minimally invasive techniques, can be extended to more complex cases where the RMT is <3 mm and future fertility is desired.

Safe Service Delivery of a Complex Early Pregnancy Problem: Caesarean Scar Pregnancy.

Caesarean Scar Pregnancy (CSP) is an ectopic pregnancy with implantation into the niche of the uterine scar. We aimed to describe the local management of consecutive cases of CSP to develop a standard operating procedure (SOP). Between December 2019 and June 2022, there were 19,100 maternities. Of these, 23 were CSPs in 19 patients. Median BMI was 29 (range 20.5-52), median number of Caesarean deliveries (CS) was 2 (range 1-4) and 7/23 (30%) were cigarette smokers. At diagnosis, 9/23 were live pregnancies, 3/23 were retained products of conception (RPOC), 9/23 were pregnancies of uncertain viability (PUV), and 2/23 were non-viable. In six, the initial management was expectant, surgical suction evacuation with transrectal ultrasound guidance in 16, and one had a hysterectomy. The median blood loss was 100 mL (range 50-2000 mL). Two patients (9%) required a blood transfusion. Median hospital stay was 1 day (range 0-4). At follow-up after 10 weeks, no patients had an ongoing haematoma, and one had significant RPOC electing hysterectomy. Eight women were known to have 9 subsequent pregnancies (recurrent CSP n = 4, livebirth n = 2, miscarriage n = 2, tubal ectopic n = 1). Outcomes as rated by low blood loss, short hospital stay, and rare need for further intervention were favorable. Factors associated included prompt ultrasonographic diagnosis, availability of transrectal ultrasound guided surgery, and specialist follow-up, which form the basis of the SOP.

Cesarean scar pregnancy mimicking a pseudo-gestational sac: A case report with magnetic resonance imaging findings

Introduction: A corpus luteal cyst may reportedly be misidentified as an ectopic gestational sac. We report a case of cesarean scar pregnancy mimicking a pseudo-gestational sac, to differentiate between the two entities and diagnose correctly. Case Report: A 42-year-old woman with four previous cesarean sections, at 7 weeks of gestation, was suspected of an unknown site pregnancy. Transvaginal Doppler ultrasonography showed a small cystic structure accompanied by neither a yolk sac nor surrounding marginal flow, adjacent to the uterine scar, and a 16-mm-large low-echo area with a white ring in the left adnexa. Pelvic magnetic resonance imaging also demonstrated a small cystic structure without contrast enhancement resembling a pseudo-gestational sac adjacent to the cesarean scar. Moreover, a cystic structure with ring-enhancement beside the left ovary, which mimicked an ectopic gestational sac, was also detected. Given these imaging findings and slightly elevated serum β-human chorionic gonadotropin (β-hCG) levels, ectopic pregnancy in the left fallopian tube could not be ruled out. She underwent laparoscopic surgery and uterine content removal, which resulted in intrauterine miscarriage. The cystic structure partially resected from a marginal area in the ovary appeared to be a luteal cyst. Conclusion: For correct diagnosis and appropriate treatment, the clinical circumstances should be fully considered without excessive reliance on imaging findings.

Expectant management of viable cesarean scar pregnancies: a systematic review.

Cesarean scar pregnancy (CSP) is a potentially life-threatening disease that has been steadily increasing in prevalence. Pregnancy termination is usually recommended given the risk of life-threatening complications. In some cases, patients refuse to terminate viable CSPs, even after counseling. Recent studies report that, even with a high burden of possible complications and maternal morbidity, many CSPs progress to live, close to term births. The aim of this study is to further demonstrate the natural history of viable cesarean scar pregnancies. We conducted a systematic review of original studies reporting cases of expectant management of CSPs with positive fetal heartbeats. After selection, 28 studies were included in the review, with a total of 398 cases of CSP, 136 managed expectantly and 117 with positive fetal heartbeat managed expectantly. This study confirmed that the majority of patients experience live births, as 78% of patients selected for expectant management experienced live births at or close to term, with 79% developing morbidly adherent placenta, 55% requiring hysterectomy, and 40% having severe bleeding. The optimal management protocol for CSP is still to be defined and more studies are needed to further elucidate this rare but rising disease. Our study provides information on the natural history of untreated CSPs and suggests that termination may not be the only option offered to the patient.

A nomogram to predict the risk of scar pregnancy after caesarean section

The aim of this study was to identify the high-risk factors for caesarean scar pregnancy (CSP) and establish a nomogram to predict the risk of caesarean scar pregnancy in pregnant women with a history of caesarean section. Among 1273 pregnant women with a history of caesarean section, 70% of the patients (892 patients, training sample) were randomly selected for analysis, and a prediction model was generated. The remaining patients (381 patients, validation sample) were validated for the model. Four high-risk factors for CSP were established, including: parity, number of previous abortions, uterus position, and early vaginal bleeding. The area under the curve of the nomogram for the training set was 0.867 and that for the validation set was 0.881, indicating good performance. Calibration curves for predicting CSP showed good calibrations. Decision curve analyses showed good application prospects for the model. Our results show that our nomogram for predicting CSP risks can be a practical tool to help in the early identification of CSP. Impact Statement What is already known on this subject? The high-risk factors for "caesarean scar pregnancy", An simple nomogram could be constructed to predict the risk of the disease through these high-risk factors. What do the results of this study add? This study can quickly predict whether the patient is a high-risk group for uterine scar pregnancy based on the patient’s previous pregnancy, early vaginal bleeding and uterine position. What are the implications of these findings for clinical practice and/or further research? Caesarean scar pregnancy was secondary Long-term complications after caesarean section that with a high risk of pregnancy. In this study, we established a nomogram based on the number of cases of CSP and a control group with a history of caesarean section delivery at term, The high-risk factors were assigned a certain risk value in the early stage, if the woman contains more high-risk factors, the higher the risk of developing CSP, it should be highly valued in the early stage, and the rate of visiting a doctor should be increased.

Hysteroscopic Removal of Residual Cesarean Scar Pregnancy

<h3>Study Objective</h3> Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy which may be managed by various medical and surgical options. We present a case series of patients managed by combined medical and hysteroscopic surgical approach. <h3>Design</h3> Retrospective review of CSP cases managed by combined methotrexate and hysteroscopy. <h3>Setting</h3> University affiliated department of Obstetrics and Gynecology. <h3>Patients or Participants</h3> 5 patients with a viable 6 weeks CSP. <h3>Interventions</h3> Administration of methotrexate (local and systemic intramuscular), with or without uterine artery embolization, followed by hysteroscopic removal of the residual pregnancy mass. <h3>Measurements and Main Results</h3> The residual CSP mass was successfully removed in 4 out of 5 cases by hysteroscopy, while one patient required a robotic assisted resection and repair of the cesarean scar due to persistent CSP. Pre-operative uterine artery embolization was performed in 2 cases for the prevention of excessive bleeding. No intra- or post-operative complications occurred. The post-operative sono-hysterography showed a residual myometrial thickness >4 mm in all cases. <h3>Conclusion</h3> Combined medical and hysteroscopic removal of viable CSP is safe and allows for fertility preservation.

Selection of Laparoscopy or Laparotomy for Treating Cesarean Scar Pregnancy: A Retrospective Study.

ObjectiveCesarean scar pregnancy (CSP) can have catastrophic consequences, but a standardized diagnosis and treatment for CSP are lacking. At least 10 different treatments are currently available, further confusing treatment selection. The aim of this study was to compare the outcomes of using laparotomy or laparoscopy to treat CSP.MethodsWe reviewed data from 935 patients with suspected CSP from 1 January 2013 to 31 December 2018. A total of 278 patients were included in the study, of whom 121 were treated with laparoscopy and 157 were treated with laparotomy. We compared and analyzed the characteristics of laparoscopic and open surgeries for treating CSP cases and the advantages and disadvantages of different vascular pretreatments.ResultsIntraoperative bleeding, the transfusion rate, total days of hospitalization and postoperative hospital length of stay were lower with laparoscopy than laparotomy (P < 0.05). There was no difference in the factors (beta human chorionic gonadotropin [β-HCG] decrease, reoperation rate and tissue residues) closely related to the success of the surgery in the two groups. Furthermore, we used different blood vessel pretreatments among patients. The rates of tissue residue, reoperation and intraoperative blood transfusion were lower in patients with temporary vascular occlusion than in patients with permanent vascular occlusion.ConclusionThis study revealed that laparoscopic surgery is superior to laparotomic surgery for treating CSP. Patients in both groups benefited from temporary arterial occlusion. Thus, temporary arterial occlusion with laparoscopic surgery may be the best treatment for CSP.

Cesarean scar pregnancy - a retrospective analysis of cases in the years 2012-2021.

With the increasing number of caesarean sections, the number of cesarean scar pregnancies (CSP) is also increasing. This is a relatively new entity of an ectopic pregnancy, which is risky mainly because of its possible association with placenta accreta spectrum. CSP is thought to represent about 6% of the total number of ectopic pregnancies in all women who have a history of at least one caesarean section. The estimated incidence of CSP is about 1/1,688 of all pregnancies and about 1/2,000 of all caesarean sections. Retrospective analysis of individual cases of cesarean scar pregnancies managed in our health care facility in the years 2012-2021. In total, we managed 16 cases of pregnancy in the caesarean scar in 15 women. In one woman, we recorded CSP twice. The mean age of the women was 36.6 years (27-41). The mean number of caesarean sections was 1.6 (1-3) and gestational week was 7 (4-10). The average time since the caesarean section was 3.6 years (2-11). The management was methotrexate administration once, hysteroscopic resection once and 11times primarily vacuum aspiration only, when in two cases we had to attach laparoscopic uterine artery ligation due to postoperative bleeding. We performed primary ligature of uterine arteries twice before performing vacuum aspiration. In pregnancies above 10 weeks of gestation, we observed more bleeding complications requiring surgical management. Bleeding complications were also related to the presence of fetal cardiac action. Early correct dia-gnosis is essential in the management of CSP. Pregnancies up to the 10th week of gestation are managed by simple vacuum aspirations under ultrasound guidance. If the pregnancy is over the 10th week of gestation and especially with cardiac activity, we add laparoscopic uterine artery ligation before vacuum aspiration. All patients are subsequently advised to undergo laparoscopic resuturing of the lower uterine segment.

Local treatment with methotrexate of cesarean scar pregnancy: A case report

Cesarean scar pregnancy, is the implantation of a gestational sac within the myometrium at the side of previous cesarean section scar, is a rare type of ectopic pregnancy. Ultrasonography is the first and most important diagnostic method of this condition. Increased suspicion with widespread use of ultrasound lead to the recognition of most cases of Cesarean scar pregnancy in early pregnancy. This allows for rapid interventions and preservation of the uterus and fertility. The use of conservative treatments, including medical treatment, especially with methotrexate, saves from surgeries such as hysterectomy and preserves women's fertility. In this study, we presented a case of cesarean scar pregnancy which was successfully treated with transvaginal ultrasound-guided injection of methotrexate.

668 Three cases of diagnosis and treatment of cesarean scar pregnancy

Introduction and aims: Cesarean scar pregnancy (CSP) is an intrauterine ectopic pregnancy situated closely to a scar or within an isthmocele, surrounded by myometrium out of decidual layer. This localization of pregnancy is potentially associated with dangerous maternal complications. The management of such patients is a clinical challenge as for now a standard protocol of CSP treatment hasn’t been developed. Methods: We present 4 cases of CSP that were diagnosed and successfully managed at difference clinical stages with relevant stage-dependent approaches.

Efficacy of different treatment of 134 cases of cesarean scar pregnancy.

The aim of this study was to compare the clinical efficacy of different methods for treating cesarean scar pregnancy (CSP). The clinical data of 134 patients diagnosed with CSP in the Third Affiliated Hospital of Guangzhou Medical University were retrospectively analyzed. Grouped by treatment plan: pretreatments +ultrasound guided Curettage group (group A), pretreatments+ laparotomy (group B). Group A was sub-grouped according to the pretreatments: ultrasound guided uterine evacuation (A1), uterine arterial embolism (UAE) + ultrasound guided uterine evacuation (A2), high-intensity focused ultrasound (HIFU) + ultrasound guided uterine evacuation (A3); group B was sub-groups according to pretreatments: laparotomy (B1), UAE + laparotomy (B2). The success rates of treatment in groups A and B were 72.73%-100%, and it was statistically significant (P<0.05) There were no statistically significant in the blood loss and the degree of decrease of β-hCG in these two group (P>0.05). The operation time, length of stay and cost were statistically significant between curettage group and laparotomy group (P<0.05); there was no significant difference in the degree of β-HCG decrease (%) and surgical bleeding volume. The success rate in group A1-A3 was 64.10%, 96.52% and 100% respectively, which was statistically significant (P<0.05). No statistically significant were showed in operation time, Length of stay and the degree of decrease of β-hCG within 5 days after operation in A1-A3 group (P>0.05). The blood loss and cost between A1 and A3 groups were statistically significant (P<0.05). The success rate in group B1-B2 were both 100%, with no statistically significant (P>0.05). There were no statistically significant in operation time, blood loss, degree of decrease of β-hCG, length of stay between the two groups (P>0.05). The cost between the two groups was statistically significant (P<0.05). Ultrasound-guided uterine Curettage can be used as a better treatment for type I and II scar pregnancy. UAE or HIFU before Curettage can reduce uterine bleeding, while UAE before the laparotomy did not reduce uterine bleeding.

Safety and Efficacy of a Single Local Methotrexate Injection for Cesarean Scar Pregnancy

To investigate the safety and efficacy of a single local methotrexate (MTX) injection for the treatment of cesarean scar pregnancy (CSP), assess reproductive outcomes after treatment, and confirm clinical outcomes after the treatment of CSP patients according to the presence of fetal cardiac activity or serum human chorionic gonadotropin (hCG) levels. A retrospective cohort study. A university hospital. Women with CSP. Single local MTX injection under transvaginal ultrasound guidance. A total of 45 CSP cases were identified; the mean (standard deviation, range) estimated gestational age was 7.7 (1.7, 5.4-12.5) weeks and the mean serum hCG level was 51 801 (40 761, 2307-187 898) mIU/mL. Three cases required additional treatment with MTX, and none of the cases needed uterine artery embolization or hysterectomy. The success rate for a single dose was 93.3%, and it was 100% if additional treatments with MTX were included. The mean time required for hCG normalization in those with fetal cardiac activity or with an initial level of hCG greater than 100 000 mIU/mL was not significantly longer than that in the controls (93.4 vs 77.1 days, p=.12; 113.7 days vs 83.6 days, p=.10). Of the 23 women who desired a subsequent pregnancy, 13 delivered 14 healthy newborns after treatment, 3 had an ongoing pregnancy, and 3 experienced recurrent CSP. A single local MTX injection is safe and effective for the treatment of CSP despite the presence of fetal cardiac activity or any initial level of hCG and may allow the possibility of a subsequent uneventful pregnancy.

Scar Tissue after a Cesarean Section-The Management of Different Complications in Pregnant Women.

The definition of a cesarean scar pregnancy (CSP) is the localization of the gestational sac (GS) in the cicatrix tissue, which is created in the front wall of the uterus after a previous cesarean section (CS). The worldwide prevalence of CSP has been growing rapidly. However, there are no general recommendations regarding prophylaxis and treatment of the abnormalities of the anterior wall of the uterus discovered in a non-pregnant myometrium, or how to deal with existing cases of CSP. We present the latest knowledge, a holistic approach to the biology, histology, imaging, and management concerning post-CS scars based on our cases, which were treated in the Department of Pregnancy and Pathology of Pregnancy in the Medical University of Lublin, Poland. In our study, we present images of tissue samples of areas with a cicatrix in the uterus, and ultrasound and MRI images of CSP. We discuss the advances in the biology of the post-CS scar tissue, the prevention techniques used to repair the scar defect (niche) before the pregnancy, and the treatment of different complications of CSP, such as the rupture of the gravid uterus or the dehiscence of the myometrium.