The diagnosis, treatment, and follow-up of cesarean scar pregnancy

• Published in: American journal of obstetrics and gynecology Vol. 207; no. 1; pp. 44.e1 - 44.e13
• Main Authors: Timor-Tritsch, Ilan E., MD, Monteagudo, Ana, MD, Santos, Rosalba, RDMS, Tsymbal, Tanya, RDMS, Pineda, Grace, RDMS, Arslan, Alan A., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.07.2012; Elsevier
• Subjects: Abortifacient Agents, Nonsteroidal - administration & dosage; Abortion, Therapeutic - methods; accreta; Adult; Biological and medical sciences; Cesarean Section; cesarean section scar pregnancy; Cicatrix; ectopic pregnancy; Female; Follow-Up Studies; Gynecology. Andrology. Obstetrics; Humans; Injections, Intramuscular; Medical sciences; methotrexate; Methotrexate - administration & dosage; minimally invasive procedure; Obstetrics and Gynecology; placenta; Postoperative Complications - diagnostic imaging; Postoperative Complications - therapy; Pregnancy; Pregnancy, Ectopic - diagnostic imaging; Pregnancy, Ectopic - etiology; Pregnancy, Ectopic - therapy; punctures; Retrospective Studies; Treatment Outcome; Ultrasonography, Prenatal; ultrasound; cesarean section; minimally invasive procedure; cesarean section scar pregnancy; ectopic pregnancy; accreta; punctures; pregnancy; methotrexate; placenta; ultrasound; Pregnancy; Treatment; Surveillance; Surgery; Scar; Gynecology; Diagnosis; Obstetrics; Cesarean section
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2012.04.018

Objective The diagnosis and treatment of cesarean scar pregnancy (CSP) is challenging. The objective of this study was to evaluate the diagnostic method, treatments, and long-term follow-up of CSP. Study Design This is a retrospective case series of 26 patients between 6-14 postmenstrual weeks suspected to have CSP who were referred for diagnosis and treatment. The diagnosis was confirmed with transvaginal ultrasound. In 19 of the 26 patients the gestational sac was injected with 50 mg of methotrexate: 25 mg into the area of the embryo/fetus and 25 mg into the placental area; and an additional 25 mg was administered intramuscularly. Serial serum human chorionic gonadotropin determinations were obtained. Gestational sac volumes and vascularization were assessed by 3-dimensional ultrasound and used to monitor resolution of the injected site and outcome. Results The 19 treated pregnancies were followed for 24-177 days. No complications were observed. After the treatment, typically, there was an initial increase in the human chorionic gonadotropin serum concentrations as well as in the volume of the gestational sac and their vascularization. After a variable time period mentioned elsewhere the values decreased, as expected. Conclusion Combined intramuscular and intragestational methotrexate injection treatment was successful in treating these CSP.