Management Of Cesarean Scar Pregnancy Research Articles

Grossesse sur cicatrice de césarienne : traitement combiné avec embolisation des artères utérines avant procédure chirurgicale

ObjectivesTo offer a therapeutic management of cesarean scar pregnancies (GSC) in the first trimester of pregnancy with a first approach by uterine artery embolization (UAE) Patients and methodsThis study describes seven cases of GSC diagnosed between 2009 and 2013 in the clinic of the University Hospital of the Hospital of Croix-Rousse. We present the symptoms and how imagery has led to the diagnosis and the therapeutic management conducted. ResultsThe mean gestational age at diagnosis was 9 weeks gestation. There were ongoing pregnancies with cardiac activity present for each patient. An additional MRI was performed in five patients. Five patients were treated with methotrexate injection, two patients received the Mifegyne. All patients then received a selective uterine artery embolization. Finally within 48hours, suction curettage was performed in 6 patients. A patient at 13 WA+1 required a subtotal hysterectomy for placenta accreta. Intra-operative complications were represented by a bladder injury, two bleeding of 1000mL in patients at 13 WA+1 and 12 WA. For the 6 cases of GSC with a gestational age less than 10 WA, average blood loss was less than 500mL. Three patients underwent resection of scar isthmocele confirmed by EVAC. An intrauterine pregnancy was carried to term after care. Discussion and ConclusionCesarean scar pregnancies is a diagnostic and therapeutic challenge, which should be diagnosed as early as soon as possible with care in a medical facility with a uterine artery embolization technical platform. Our protocol combining Mifegyne and methotrexate for termination of pregnancy and uterine artery embolization (UAE) followed by curettage for evacuation of pregnancy allows conservative treatment while minimizing the risk of bleeding (for GSC diagnosed before 10 WA).

Son Bir Yılda Harran Üniversitesi Kadın-Doğum Kliniğine Gelen Sezaryen Skar Gebeliklerinin Yönetimi

Amaç: Son bir yılda Harran Üniversitesi Kadın Hastalıkları ve Doğum Kliniğine gelen sezaryen skar gebeliklerinin tanı ve tedavilerinin araştırılmadır. Gereç ve Yöntemler: Son bir yılda, gebelik ön tanısıyla kliniğimize başvuran ve skar gebeliği tanısı konan dokuz hasta retrospektif olarak değerlendirildi. Bulgular: Hastaların gravida ortalaması 5 (2-10), parite ortalaması 3 (1-5), geçirilmiş sezaryen sayısı en az bir, en fazla beş idi. Tanı esnasındaki ortalama gebelik haftası 7 idi. Hastalara transvajinal ve transabdominal ultrason kriterlerine göre sezaryen skar gebeliği tanısı konuldu. Sekiz hastaya dilatasyon ve küretaj yapıldı. Bu hastaların birinde küretaj sonrası insizyonel hematom komplikasyonu geliştiğinden laparotomi ile wedge rezeksiyon uygulandı. Bir hastaya ise laparotomi ile wedge rezeksiyon ve sol uterin arter ligasyonu uygulandı. Ortalama üçüncü günde hastalar oral antibiyotik tedavisi ile taburcu edildi. Tüm hastaların patoloji sonuçları tanı ile uyumlu geldi. Sonuç: Sezaryen skar gebelikleri nadir ve de oldukça riskli bir ektopik gebelik türüdür. Erken tanı (≤7 hafta) ve tedavi ile bu riskler en az seviyeye indirilebilir. Bu nedenle geçirilmiş uterin cerrahisi olan gebelere bir sonraki gebeliklerinde mümkün olan en erken dönemde ultrason ile tanı konularak seçilmiş olgularda konservatif tedavi yöntemleri uygulanabilir. Objective: We purposed to search the diagnosis and treatment of cesarean scar pregnancies; those, referred to Department of Gynecology, Harran University at the last year. Material and Methods: Nine patient were evaluated retrospectively. They were admitted to our clinic with diagnosis of cesarean scar pregnancy at the last year. Results: The average of gravidity was 5 (2-10), parity was 3 (1-5), they have at least one, at most five cesarean section previously. The mean of gestational age was 7 weeks during diagnosis. The diagnosis of scar pregnancy was established according to criteria of transvaginal and transabdominal ultrasound. Dilatation and curettage was performed eight patients. At the one of them, incisional hematoma was occured. So, wedge resection was required by laparotomy. Also at the one patient, wedge resection and ligation of uterine artery was performed. The patients discharged on postoperative day 3 with antibiotic therapy. The pathology results of all patients were compatible with diagnosis. Conclusion: Cesarean scar pregnancy is a rare but life threatening complication of pregnancy. The complications can be minimized by early diagnosis (≤7 week). Therefore, diagnosis should be established earlier as possible in the pregnant women with previous uterine surgery, and treatment may be done conservatively.

Transvaginal surgical management of cesarean scar pregnancy: analysis of 49 cases from one tertiary care center

ObjectiveTo investigate the safety and effectiveness of transvaginal surgical management of cesarean scar pregnancy (CSP). Study designRetrospective analysis of 49 CSP patients who received transvaginal surgery in our hospital between December 2009 and April 2013. Patients were divided into two groups. Group A (30 patients) was defined as patients who had not received any treatment before transvaginal surgical management. Group B (19 patients) referred to patients who had received any previous treatment. Preoperative, intraoperative and postoperative data of both groups were collected and analyzed retrospectively. ResultsPreoperative serum β-hCG level, preoperative hemoglobin level and average serum β-hCG resolution time of group A and group B were 53,458.50 (36,382.00–94,100.50) versus 9779.00 (932.50–29623.00)U/l, 123.87±10.95 versus 109.94±16.05g/l and 3.55±1.81 versus 1.83±1.15 weeks (P<0.05). Vaginal bleeding and gestational age in group A were significantly lower than in group B, 2.5 (0.50–11.00) versus 15.00 (3.50–31.50) days and 52.50 (46.50–56.70) versus 60.00 (48.00–90.00) days, respectively (P<0.05). The operative time, estimated blood loss, postoperative hospital stay, hospitalization expenses and menstruation recovery time of group A and group B were 56.61±24.40 versus 67.56±43.52min, 45.65±27.83 versus 76.67±50.87ml, 5.10±2.89 versus 5.33±3.99 days, 9001.94±1848.37 versus 11,032.33±5534.14 RMB and 1.16±0.47 versus 1.26±0.63 month respectively, which were similar between the two groups (P>0.05). The intraoperative complication rate in group A was significantly lower than group B, 0 (0/30) versus 21.05% (4/19) (P<0.05). The postoperative complication rate and total complication rate in group A and group B were 10.00% (3/30) versus 21.05% (4/19) and 10.00% (3/30) versus 31.58% (6/19) (P>0.05), respectively. ConclusionTransvaginal surgery is an effective and relatively safe treatment option for CSP patients.

Three-dimensional computed tomographic angiography in the diagnosis and conservative management of cesarean scar pregnancy with prominent neovascularization

ObjectiveCesarean scar pregnancy (CSP) is a rare potentially life-threatening form of ectopic gestation. However, optimal management has not yet been established. Furthermore, there are limited reports on the diagnostic value of three-dimensional computed tomographic angiography (3D-CTA) for the conservative management of this disorder. Case reportA 33-year-old woman (gravida 3, para 2), with two previous deliveries by low segmental transverse cesarean section, was referred after 5 weeks of amenorrhea. Her serum beta-human chorionic gonadotropin (β-hCG) value was 2921 mIU/mL. Cesarean scar pregnancy was diagnosed by ultrasonography and magnetic resonance imaging. On 3D-CTA, a prominent uteroplacental neovascularized mass was identified. It was supplied by the left uterine artery and a thick draining left ovarian vein. After three cycles of systemic methotrexate (MTX) administration, the serum β-hCG value decreased to 142 mIU/mL. However, the gestational sac enlarged and peritrophoblastic blood flow persisted. In contrast to the ultrasonographic findings, marked reduction of uteroplacental neovascularization at the CSP site with regression of the draining ovarian vein was evident on 3D-CTA. The gestational products were thereafter successfully resected by hysteroscopic surgery without hemorrhagic complications. Fifty-seven days after the initial MTX administration, serum β-hCG reached a normal level. ConclusionThis case emphasizes that, when selecting the method of intervention, 3D-CTA is potentially useful for evaluating uteroplacental neovascularization in a hemodynamically stable CSP.

Surgical management of cesarean scar pregnancies – A single tertiary experience

Abstract Cesarean scar pregnancies (CSPs) are a rare complication of previous cesarean deliveries. As cesarean section rates continue to increase worldwide, the incidence of CSPs is likely to rise as well. The diagnosis and management of CSPs pose challenging problems to clinicians. Early accurate diagnosis is crucial, as CSP is a life-threatening emergency that can lead to potentially catastrophic consequences such as uterine rupture, hemorrhage, loss of fertility and maternal death. There is no general consensus, however, regarding the best means of management. Various case reports and case series have reported successful outcomes with medical treatment, surgical intervention, interventional radiology, as well as a combination of methods. We present a case series of CSPs managed in our center, a tertiary obstetrics and gynecology hospital. All were treated primarily by conservative and fertility-sparing surgical methods. We have also included a short review of the current literature on this rare but important condition.

Successful Surgical and Medical Management of Cesarean Scar Pregnancy in 2 Patients

Background: Cesarean scar pregnancy (CSP), once a rare entity, is on the rise due because of an increase in the cesarean section rate worldwide. Currently, there is no standard protocol available for managing CSP. To contribute to the existing literature, this article presents the current authors' experience with 2 cases of CSP that were treated successfully with two different modalities. Cases:Case 1: A 34-year-old, gravida 2, para 1, was diagnosed with a CSP on initial transvaginal ultrasound (TVUS) scan at 6 weeks of gestation. Aspiration of the gestational sac and a local injection of methotrexate was performed. After 2 weeks, the gestational sac increased in size with thinning of the CS scar (1 mm), and plateauing of the ß–human chorionic gonadotropin (ß-hCG) occurred. Laparoscopic excision of the CSP and myometrial repair resulted in resolution. Case 2: A 31-year-old, gravida 3, para 1, achieved pregnancy after a frozen–thawed embryo transfer cycle. A TVUS scan, performed at 6 weeks of gestation showed a CSP. The patient's ß-hCG level was 310 mIU/mL. Systemic methotrexate was administered intramuscularly. The patient's ß-hCG on days 4 and 7 was 260 and 252, respectively. A repeat TVUS on day 7 showed a resolving gestational sac. A second dose of methotrexate resulted in complete resolution of the CSP. Results: The treatments (aspiration, methotrexate, and laparoscopic excision for Case 1, and methotrexate for Case 2) enabled resolution of the CSPs of these 2 patients. Conclusions: Various treatment modalities have been described for managing CSP with varied levels of success. When local injection of methotrexate into the gestational sac of CSP is unsuccessful, laparoscopic removal is safe and effective. Moreover, in the presence of low levels of β-hCG, treatment with systemic methotrexate is usually successful. (J GYNECOL SURG 30:168)

Management of cesarean scar pregnancy with suction curettage: a report of four cases and review of the literature

To present the outcomes of four cases of cesarean scar pregnancy treated with suction curettage. Four patients were ultrasonographically diagnosed with cesarean scar pregnancies treated with suction curettage in a tertiary care center. Serum β-human chorionic gonadotropin levels ranged between 1,681 and 15,573 mU/mL, gestational sac diameter measured from 10 to 24 mm and scar thickness was between 4.7 and 6.8 mm. All patients underwent suction curettage under general anesthesia with transabdominal ultrasonography guidance. No complications were observed during or after operation. Suction curettage is a viable alternative for conservative treatment in selected cases of patients who are diagnosed with CSP early in gestation and who have a myometrial thickness of more than 4.5 mm.

Ineffectual Medical Treatment of Cesarean Scar Ectopic Pregnancy With Systemic Methotrexate: A Report of Two Cases.

The implantation of a pregnancy within the scar of a previous cesarean section is known as a “cesarean scar pregnancy.” Its incidence was reported to be 6.1%. However, with the increasing rates of cesarean sections, the incidence is expected to rise. A variety of conservative and surgical treatment modalities have been proposed for the management of cesarean scar pregnancy; however, there are no optimal universal treatment guidelines because of its rarity. Treatment should be tailored to the individual patient. It is obvious that more scar pregnancies will be seen in the future and therefore a set of criteria for the choice of various modes of management should be developed. Here, we present 2 cases of cesarean scar pregnancies treated with a local injection of potassium chloride after the failure of methotrexate administration.

Management of Cesarean Scar Pregnancy

To evaluate the diagnosis and treatment and long term follow up of cesarean scar pregnancy. Methods: From January 2008 to December 2013, 12 cases of Cesarean scar pregnancy were diagnosed using transvaginal grey scale and color doppler ultrasound and managed by various approaches. Incidence, gestational age, ulrasound findings, serum beta-human chorionic gonadotropin ( beta-hCG) levels, flow profiles of transvaginal color doppler ultrasound, and different methods of treatment were recorded. Results: The incidence of cesarean scar pregnancy was 1:2051. Gestational age at diagnosis ranged from 5 weeks + 2days to 10weeks + 4 weeks. The time interval from the last cesarean section to the diagnosis of Cesarean scar pregnancy ranged from 5 months to 8 years. Patients were treated by different methods as follows: transvaginal ultrasound-guided injection of methotrexate(MTX) into the gestational sac (n = 1), systemic methotrexate administration alone (n = 2), dilatation and curettage (n = 3), or local resection of the gestation mass (n =6 ). After local or systemic MTX, high-velocity and low-impedance subtrophoblastic flow (resistance index (RI) = 0.35) persisted until beta-hCG returned to normal. One of 3 patients, treated by dilatation and curettage, underwent a hysterectomy because of uncontrolled profuse vaginal bleeding. The scar pregnancy mass took 2 months to 8 months for regression after treatment. None of the patient had uterine rupture. Conclusion: Sonography guided methotrexate injection and/or systemic methotrexate are the treatment of choice to manage cesarean scar pregnancy less than 6-8 week's gestation without fetal heart activity. Dilatation and curettage leads to profuse vaginal bleeding and not recommended for cesarean scar pregnancy due to high morbidity. Those patients having persistent pain and recurrent bleeding, surgical resection for removal of mass and repair of defective site should be recommended.

High-intensity focused ultrasound combined with dilatation and curettage for Cesarean scar pregnancy

We describe a new technique for the management of Cesarean scar pregnancy (CSP), high-intensity focused ultrasound (HIFU) combined with dilatation and curettage (D&C), in four patients managed at our university hospital. All four had elevated serum human chorionic gonadotropin (hCG) levels and large lesions with strong peripheral color Doppler signals, indicating possible risk of profuse bleeding, and all four women wished to preserve their fertility. HIFU was performed under local anesthesia. Success of the treatment in all four cases was indicated by complete primary evacuation of the CSP and return of serum hCG to normal levels (serum hCG < 20 mIU/mL). However, one patient in whom there was a large scar defect and placental implantation underwent laparotomy to remove the trophoblastic tissue and repair the defect, although the hCG level had already returned to normal levels. HIFU, by utilizing ultrasound energy to heat tissue at a focal point, is able to stop embryonic cardiac activity and leads to a rapid reduction in serum hCG levels. Subsequent D&C under hysteroscopic guidance enables complete removal of products of conception following the HIFU procedure.

Conservative management of cesarean scar pregnancy by local injection of ethanol under hysteroscopic guidance

Conservative management of cesarean scar pregnancy by local injection of ethanol under hysteroscopic guidance

Temporary Bilateral Uterine Artery Occlusion Combined With Vasopressin in Control of Hemorrhage During Laparoscopic Management of Cesarean Scar Pregnancies

Study ObjectiveTo describe temporary bilateral uterine artery occlusion with titanium clips in combination with vasopressin as an effective surgical intervention to control hemorrhage during laparoscopic management of cesarean scar pregnancies (CSPs). DesignRetrospective study (Canadian Task Force classification III). SettingUniversity hospital in an obstetrics and gynecology department. InterventionsFive patients with CSPs underwent removal of gestational ectopic masses via laparoscopy. At the beginning of the procedure, all 5 women had temporary bilateral uterine artery occlusion with titanium clips, and vasopressin 6 U was injected into the myometrium. Measurements and Main ResultsClinical data, serum β-human chorionic gonadotropin levels, operative times, and operative blood loss levels were recorded. The mean gestational age at the time of CSP diagnosis was 9.2 ± 1.9 weeks. The mean serum β-hCG level on the day of surgery was 14262 ± 12870 IU/L. The mean operative time was 86 ± 21.6 minutes, the mean uterine artery occlusion time was 58 ± 13.8 minutes, and the mean blood loss was 144 ± 79.6 mL. No cases were converted to laparotomy, no blood transfusions were required, and there were no complications. ConclusionsLaparoscopy combined with titanium clip occlusion of the uterine arteries bilaterally with vasopressin injection is an effective, minimally invasive procedure to preserve the uterus in patients with a CSP.

Abruptio Placentae in Subsequent Pregnancy after Conservative Management of Hemorrhagic Cesarean Scar Pregnancy by Transcatheter Arterial Chemoembolization

IntroductionCesarean scar pregnancy is a rare but dangerous type of ectopic pregnancy in which implantation occurs within the fibrous tissue of a cesarean scar defect. Conservative management of cesarean scar pregnancy is challenging, especially when future fertility preservation is a significant concern. Furthermore, reports on significant maternal morbidity in subsequent pregnancies after successful conservative management of cesarean scar pregnancy are limited.Case reportA 31-year-old woman with previous history of 2 cesarean sections transferred due to massive uterine hemorrhage 7 weeks after dilatation and curettage performed under the diagnosis of missed abortion at 7 weeks of gestation. Cesarean scar pregnancy was diagnosed and was conservatively managed by emergent transcatheter arterial chemoembolization (TACE) followed by multiple doses of systemic methotrexate administration. Seven months after TACE, she spontaneously conceived. At 36 weeks and 5 days of pregnancy, emergency cesarean section was performed due to sudden massive hemorrhage. Abruptio placentae was diagnosed when hysterotomy was performed. After manual removal of the placenta, a healthy infant was delivered. The postoperative course was uneventful.ConclusionThe pregnancy course should be carefully monitored for early detection of maternal morbidity associated with placental abnormalities to achieve successful outcome in subsequent gestations after conservative management of cesarean scar pregnancy.

Laparoscopic Management or Laparoscopy Combined with Transvaginal Management of Type II Cesarean Scar Pregnancy

To evaluate the clinical effectiveness of laparoscopic management of cesarean scar pregnancy (CSP) by deep implantation. A pregnancy implanting within the scar from a previous cesarean delivery is a rare condition of ectopic pregnancy. There are two different types of CSPs. Type I is caused by implantation of the amniotic sac on the scar with progression toward either the cervicoisthmic space or the uterine cavity. Type II (CSP-II) is caused by deep implantation into a previous CS defect with infiltrating growth into the uterine myometrium and bulging from the uterine serosal surface, which may result in uterine rupture and severe bleeding during the first trimester of pregnancy. Thus, timely management with an early and accurate diagnosis of CSP-II is important. However, laparoscopic management in CSP-II has not yet been evaluated. Eleven patients with CSP-II underwent conservative laparoscopic surgery or laparoscopy combined with transvaginal bilateral uterine artery ligation and resection of the scar with gestational tissue and wound repair to preserve the uterus from March 2008 to November 2011. Patients with CSP-II were diagnosed using color Doppler sonography, and the diagnosis was confirmed by laparoscopy. The operation time, the blood loss during surgery, the levels of β-human chorionic gonadotropin (β-hCG) before surgery, the time taken for serum β-hCG levels to return to <100 mIU/mL postoperatively, and the time for the uterine body to revert to its original state were retrospectively analyzed. All 11 operations were successfully performed using laparoscopy with preservation of the uterus. One patient underwent a dilation and curettage after laparoscopic bilateral uterine artery ligation. Eight patients were treated solely by laparoscopic bilateral uterine artery ligation and resection of the scar with gestational tissue and wound repair. The remaining two patients underwent laparoscopic bilateral uterine artery ligation and transvaginal resection of the CS with gestational tissue and wound repair because of dense adhesions and heavy bleeding. The average operation time was 85.5 (±17.5) minutes, and the blood loss was 250.0 (±221.4) mL. The blood serum level of β-hCG returned to <100 mIU/mL in 16.4 (±5.3) days postoperatively. Among the 10 patients who underwent resection of CS and wound repair, the time for the uterus to revert to its original state (judged by ultra-sonography) was 10.8 (±3.0) days postoperatively. Laparoscopy can remove ectopic gestational tissue and allow subsequent wound repair, as well as provide diagnostic confirmation. Being a minimally invasive procedure, laparoscopic or laparoscopy combined with transvaginal bilateral uterine artery ligation and resection of the scar with gestational tissue and wound repair can become an effective alternative for the treatment of CSP-II.

Dilemma in the Management of Caesarean Scar Pregnancy

Dilemma in the Management of Caesarean Scar Pregnancy

Management of cesarean scar pregnancy by hysteroscopy combined with uterine artery embolism

To investigate safety and efficacy of hysteroscopy in treatment of cesarean scar pregnancy (CSP). From Aug. 2003 to Dec. 2011, 33 cases with CSP treated by hysteroscopy guided by transabdominal ultrasound or laparoscopy were studied retrospectively in Women's Hospital, School of Medicine, Zhejiang University. The clinical characteristics including gestational age, myometrial thickness anterior to the CSP, β-hCG level before treatment, success rate, cure rate, operative time, blood loss, time of serum β-hCG resolution and CSP mass clearance, and complication were collected and analyzed. Median gestational age was 54 days (range, 37 - 140 days). Median level of β-hCG before treatment was 15 000 U/L (range, 3.3 - 151 747 U/L). Mean thickness of anterior myometrium was 3.3 mm. Twenty-nine cases underwent uterine artery embolism (UAE) before hysteroscopy. Pouch in the anterior uterine isthmus with gestation masses implanted were observed in 30 cases (91%, 30/33). CSP masses progressed toward the pouch or uterine cavity in all cases was removed by cutting wire loop electrode combined with curettage. The mean operative time was (34 ± 10) minutes. Both success rate and cure rate were 94% (31/33). Salvage methotrexate (MTX) therapy was administrated in one case. Complication occurred in three cases (9%, 3/33). Both massive hemorrhage rate and hysterectomy rate were performed in two cases (6%, 2/33). No uterine perforation occurred. The mean time of hCG resolution was (22 ± 10) days. The mean time of CSP mass clearance was (21 ± 12) days. Four pregnancies were achieved in four cases: one term pregnancy and three abortions. No recurrent CSP occurred. Management of CSP by hysteroscopy combined with UAE is safe and effective.

A Life Away from Home: Pregnancy at the Caesarean Section Scar

Pregnancy of the caesarean scar is one of the rare types of ectopic pregnancy. It is a pregnancy implanted on a previous Caesarean Section (CS) scar. The case presented aimed to report the demography, pathophysiology, clinical presentation, most appropriate methods of diagnosis and management, with their implications in clinical practice for this rare case of ectopic pregnancy. This is a 30 years of age Gravida 3 Para 1 (1-0-1-1) who developed pregnancy of the CS Scar after full term delivery via the abdominal route. Patient wanted to save her uterus contemplating for future pregnancy. Bioethics committee was consulted. A conservative management thru methotrexate injection was done. After the first cycle of the drug, there was no resolution of the placenta and a live pregnancy was noted. Patient was scheduled for another course of methotrexate therapy, but opted to undergo surgical hysterectomy. A thorough study on the best management of Cesarean scar pregnancy is needed in order to preserve fertility and reduce morbidity.

Successful management of cesarean scar pregnancy at 13 weeks of gestation by uterine artery embolization: A case report

Cesarean scar pregnancy, in which the pregnancy is implanted at the previous cesarean scar, is a very rare form of ectopic pregnancy. A delay in diagnosis can lead to uterine rupture, massive hemorrhage, and serious maternal morbidity. However, the optimal treatment is unknown. We experienced a case of viable cesarean scar pregnancy diagnosed at 13 weeks of gestation treated with uterine artery embolization and report with a brief of literatures.

Correlation Questions Clinical Discussion of Uterine Artery Embolization in Induced Abortion Patients with Management of Cesarean Scar Pregnancy

Objective To analyze retrospectively the utility of uterine arterial embolization (UAE) for cesarean scar pregnancy (CSP). Methods Fifty-one women with CSP were pretreated with UAE before dilatation & curettage (D&C). Indexes such as blood loss volume, operation-associated complications, serum hCG level, ultrasound imaging and hospitalization cost were analyzed. Results Thirty-eight women accepted D&C following UAE (group A), 10 patients had medicine (3 took trichosanthin injection, 7 took MTX injection) before UAE and D&C (group B). Uterine packing following emergency UAE were performed in another 3 women due to severe hemorrhage during direct curettage without pretreatment (group C). There were no statistically significant differences between group A and group B about the serum β-hCG level resolution time and the blood loss in the opertation. Patients had shorter duration of hospital stay (P Conclusion Pretreatment with UAE before curettage is safe and effective in terminating CSP, reducing hospitalization cost. UAE followed by curettage is recommended to medical facilities where UAE is available.

OC60: The efficacy of surgical and conservative management of Cesarean scar pregnancies

Cesarean scar pregnancy is a rare form of ectopic pregnancy, which is associated with significant complications. There is no consensus about the optimal management of scar ectopics and the aim of the study was to compare the effectiveness of surgical and conservative treatment. Women with Cesarean scar pregnancies managed in our unit from 1999 to 2007 were included in the study. Conservative management was either expectant or medical treatment with local methotrexate. Surgical management consisted of evacuation of the scar pregnancy and insertion of a Shirodkar cervical suture to achieve hemostasis. In cases of viable scar pregnancies ≥ 6 weeks' gestation intrachorionic methotrexate was administered locally a week prior to the surgical evacuation. Complications of each management option, such as the need for blood transfusion, repeat evacuation for retained products and hysterectomy, were recorded. The success of treatment was defined as a complete resolution of clinical symptoms, hCG decline to < 25 IU and no ultrasonic evidence of retained trophoblastic tissue. A total of 59 cases were managed in our department; 46/59 (78%) women were treated surgically and 13/59 (22%) conservatively. The success of surgical management was 43/46 (93%; 95% CI, 86–100), which was significantly better in comparison to 8/13 (62%; 95% CI, 36–88) in the non-surgical group (X = 6.3, P = 0.01). Two of 46 (4%; 95% CI, 0–10) women in the surgical and 2/13 (15%; 95% CI, 0–34) in medical group required blood transfusions (P > 0.05). Surgery is more effective than conservative treatment of Cesarean scar ectopic pregnancies and it should be used as the first management option in most cases.