Successful Conservative Treatment of Cesarean Scar Pregnancy with Systemic Methotrexate Injection: A Case Report
Irwan Muhaeimin H.M(1*), Irwan Taufiqur Rahman(2), Shofwal Widad(3)
(1) PPDS Obstetri dan Ginekologi FKKMK UGM
(2) Departemen Obstetri dan Ginekologi FKKMK UGM
(3) Departemen Obstetri dan Ginekologi FKKMK UGM
(*) Corresponding Author
Abstract
Cesarean scar pregnancy (CSP) is a rare but life-threatening complication. It is the abnormal implantation of gestational sac into myometrium and fibrous scar of previous cesarean section. Its incidence is on rising trend due to increase in rate of cesarean section all over the world. A thirty one-year old third gravida presented at five weeks of gestation with complaints of vaginal spotting. She was diagnosed as a case of cesarean scar pregnancy (CSP) on ultrasonography. Conservative management of CSP was done successfully with the injection of systemic methotrexate. CSP pregnancy could be catastrophic, if not managed well in time. Management includes both surgical and medical options. The optimal management of caesarean section pregnancy should be individualized depending upon the hemodynamic status depending on patient’s hemodynamic profile, size of gestational sac, desire for future fertility, and patient’s preference.
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- Spychała, P. and Nowakowski, B., 2012. Laparoscopic management of an ectopic pregnancy in a previous caesarean section scar. Ginekologia polska, 83(8), pp.622-625.
- Valley, M.T., Pierce, J.G., Daniel, T.B. and Kaunitz, A.M., 1998. Cesarean scar pregnancy: imaging and treatment with conservative surgery. Obstetrics & Gynecology, 91(5), pp.838-840.
- Rotas, M.A., Haberman, S. and Levgur, M., 2006. Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstetrics & Gynecology, 107(6), pp.1373-1381.
- Wong, K.S., Tan, J., Ang, C. and Ngu, A., 2010. Myomectomy scar ectopic pregnancy. Australian and New Zealand journal of obstetrics and gynaecology, 50(1), pp.93-94.
- Marchiole, P., Gorlero, F., De Caro, G., Podesta, M. and Valenzano, M., 2004. Intramural pregnancy embedded in a previous cesarean section scar treated conservatively. Ultrasound in Obstetrics and Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology, 23(3), pp.307-309.
- Ash, A., Smith, A. and Maxwell, D., 2007. Caesarean scar pregnancy. BJOG: An International Journal of Obstetrics & Gynaecology, 114(3), pp.253-263.
- Vial, Y., Petignat, P. and Hohlfeld, P., 2000. Pregnancy in a cesarean scar. Ultrasound in Obstetrics and Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology, 16(6), pp.592-593.
- Calì, G., Timor‐Tritsch, I.E., Palacios‐Jaraquemada, J., Monteaugudo, A., Buca, D., Forlani, F., Familiari, A., Scambia, G., Acharya, G. and D'Antonio, F., 2018. Outcome of Cesarean scar pregnancy managed expectantly: systematic review and meta‐analysis. Ultrasound in Obstetrics & Gynecology, 51(2), pp.169-175.
- Jurkovic, D. and Wilkinson, H., 2011. Diagnosis and management of ectopic pregnancy. BMJ, 342.
- Seow, K.M., Cheng, W.C., Chuang, J., Lee, C., Tsai, Y.L. and Hwang, J.L., 2000. Methotrexate for cesarean scar pregnancy after in vitro fertilization and embryo transfer. A case report. The Journal of reproductive medicine, 45(9), pp.754-757.
- Godin, P.A., Bassil, S. and Donnez, J., 1997. An ectopic pregnancy developing in a previous caesarian section scar. Fertility and sterility, 67(2), pp.398-400.
- Persadie, R.J., Fortier, A. and Stopps, R.G., 2005. Ectopic pregnancy in a caesarean scar: a case report. Journal of Obstetrics and Gynaecology Canada, 27(12), pp.1102-1106.
- Sugawara, J., Senoo, M., Chisaka, H., Yaegashi, N. and Okamura, K., 2005. Successful conservative treatment of a cesarean scar pregnancy with uterine artery embolization. The Tohoku journal of experimental medicine, 206(3), pp.261-265.
- Yang, M.J. and Jeng, M.H., 2003. Combination of transarterial embolization of uterine arteries and conservative surgical treatment for pregnancy in a cesarean section scar. A report of 3 cases. The Journal of reproductive medicine, 48(3), pp.213-216.
- Fylstra, D.L., 2002. Ectopic pregnancy within a cesarean scar: a review. Obstetrical & gynecological survey, 57(8), pp.537-543.
- Kung, F.T., Huang, T.L., Chen, C.W. and Cheng, Y.F., 2006. Cesarean scar ectopic pregnancy. Fertility and sterility, 85(5), pp.1508-1509.
- Shufaro, Y. and Nadjari, M., 2001. Implantation of a gestational sac in a cesarean section scar. Fertility and sterility, 75(6), p.1217.
- Ben Nagi, J., Helmy, S., Ofili-Yebovi, D., Yazbek, J., Sawyer, E. and Jurkovic, D., 2007. Reproductive outcomes of women with a previous history of Caesarean scar ectopic pregnancies. Human Reproduction, 22(7), pp.2012-2015.
- Maheux-Lacroix, S., Li, F., Bujold, E., Nesbitt-Hawes, E., Deans, R. and Abbott, J., 2017. Cesarean scar pregnancies: a systematic review of treatment options. Journal of minimally invasive gynecology, 24(6), pp.915-925.
- Peng, P., Gui, T., Liu, X., Chen, W. and Liu, Z., 2015. Comparative efficacy and safety of local and systemic methotrexate injection in cesarean scar pregnancy. Therapeutics and clinical risk management, 11, p.137.
- Lam, P.M., Lo, K.W.K. and Lau, T.K., 2004. Unsuccessful medical treatment of cesarean scar ectopic pregnancy with systemic methotrexate: a report of two cases. Acta obstetricia et gynecologica Scandinavica, 83(1), pp.108-111.
DOI: https://doi.org/10.22146/jkr.83215
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