Objective:To demonstrate the efficacy of management for cesarean scar ectopic pregnancies up to 8 weeks’ gestation using ultrasound-guided Foley balloon catheter placement combined with dilation and curettage (D and C) at TuDu Hospital.Subjects and Methods:A quasi-experimental study was conducted from March 2015 to March 2016. Patients with imaging-confirmed cesarean ectopic pregnancies were admitted to an inpatient unit at Tu Du Hospital. A Foley balloon catheter was placed inside the uterus under ultrasound guidance and was left in place for 24 h. Afterward, the patient underwent ultrasound-guided D and C. Follow-up to confirm success included serial blood draws to measure beta-human chorionic gonadotropin (β-hCG) levels until a value of 0, and routine ultrasounds to confirm absence of a gestational sac and no evidence of vascularity at the site of the cesarean section scar.Results:A total of 311 patients were enrolled over 3 months. Overall, 90.7% (95% confidence interval [CI]: 86.8%–93.9%) patients were successfully treated with this regimen. Several factors that were significantly associated with successful management included gestational age <6 weeks (odds ratio [OR] 3.1, 95% CI: 1.03%–8.76%), β-hCG level <11,000 mUI/mL before discharge from the hospital (OR 6.5, 95% CI: 1.42%–30.6%), gestational sac volume 2 weeks after treatment measuring <5 cm3 (OR 9.1, 95% CI: 1.96%–50.1%).Conclusions:This is an easily applicable method with a short follow-up period and reduction in treatment costs compared to standard treatment with methotrexate injection.

Objectives: This study aims to identify the success rate and correlated factors of combined local and systemic methotrexate (MTX) injection treatment in cesarean scar pregnancy (CSP). Materials and Methods: The combined local and systemic MTX administration has been used for CSP weeks 8–14 at Tu Du Maternal Hospital; however, its effectiveness and correlated factors have not been closely investigated. This is a retrospective case series of 123 CSP patients between 8 and 14 weeks of gestation who were treated at Tu Du Hospital from the year 2016 to 2020. Results: The success rate, uterine-sparing rate, and side effects of MTX treatment are 50.4%, 95%, and 17.2%, respectively. The factors related to treatment failure with statistical significance included gestational age (odds ratio [OR] = 3.99), residual myometrial thickness >3 mm (OR = 0.37), and postprocedure gestational sac diameter (OR = 1.09). Conclusion: Combined local and systemic MTX injection is minimally invasive and effective in CSP weeks 8–14. Therefore, it should be utilized routinely.

Objectives: An earlier study completed at TuDu Hospital presented the efficacy of Foley insertion combined with fetal suction curettage at a high rate of success in treatment of cesarean scar pregnancy (CSP) of < 8 weeks, but the efficacy of prognosticating factors for this approach has not been specifically addressed yet, especially crossover sign (COS) on ultrasound. We aimed to investigate the correlation between COS on ultrasound and the treatment results of CSP using Foley insertion combined with fetal suction. Materials and Methods: A case–control study of CSPs ≤ 8 weeks treated at TuDu Hospital during September 2017–April 2019 included 63 failures in the case group and 98 successes in the control group. Results: COS-2 + increased the likelihood of treatment success by 4.9 times (95% confidence interval: 1.8–13.5) compared with COS-1 cases. In addition, other factors favoring treatment success with statistical significance included no vascularization at cesarean scar on ultrasound (odds ratio [OR] = 7.1), gestational mass volume ≤4 cm3 (OR = 3.7), and β-human chorionic gonadotropin at hospital admission ≤ 10,000 mIU/mL (OR = 6.1). Conclusion: COS imaging played an important role in the prediction of treatment outcomes for CSP ≤ 8 weeks by the combined approach of Foley insertion and fetal suction curettage.

Objective: To evaluate the efficacy of laparoscopic surgery in the treatment of cesarean scar ectopic pregnancy compared with other modalities. Design: Case report. MP4 video clip, 5.10 minutes in length. Settings: A hospital. Patients: A 38 year old, gravid 2, para 1, with history of previous cesarean section in 2013 was admitted to the emergency department with vaginal bleeding and a positive pregnancy test. Transvaginal ultrasonography revealed a vascularized amorphous 4 cm in diameter mass surrounding a gestational sac at 10 -12 weeks located to the scar of the previous cesarean section. Ultrasound guided dilation and curettage was indicated, followed by Foley catheter insertion. After that, the pregnancy mass increased to 7 cm in diameter and the thickness of the uterine wall between the bladder and the gestational sac was thinner. Laparoscopic treatment was considered. Interventions: Laparoscopic bilateral uterine artery ligation was performed, followed by a sharp dissection of the vesicouterine peritoneal fold and removal of the ectopic pregnancy located in the dehiscent scar. Then, bipolar coagulation and suturing of the defect in two layers were done, followed by peritonealization. Measurements/Results: The total operative time was 120 minutes. Intraoperative blood loss was 50 mL. No immediate complications were noticed. The patient was discharged on postoperative day 2 with the decrease in serum β-hCG levels. At 1 month after the intervention, ultrasound was normal. Conclusions: Surgical management of caesarean scar pregnancy and repair of scar defect can be performed safely and efficiently with laparoscopy.