A large intrauterine vascular lesion developing after the successful treatment of a cesarean scar pregnancy with methotrexate injection

Song, Jang Ho; Ju, Da Hye; Yi, Sang‐Wook; Lee, Joo Hee; Sohn, Woo Seok; Lee, Sang Soo

doi:10.1002/jcu.22490

Cited by 2 publications

(1 citation statement)

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“…CSP may transform into a large vascular tumor (categorized as our grade IV), typically after MTX treatment or uterine evacuation for a pre-existing CSP [ 27 – 30 ]. In this particular situation, catastrophic bleeding often occurs during surgical intervention, in which case UAE was usually required for hemostasis.…”

Section: Discussionmentioning

confidence: 99%

New ultrasound grading system for cesarean scar pregnancy and its implications for management strategies: An observational cohort study

Lin

Hsieh

et al. 2018

PLoS ONE

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A cesarean section pregnancy (CSP) indicated the gestational sac (GS) implanted in the previous cesarean scar. The clinical manifestations of CSP present a wide range of variations, and the optimal management is yet to be defined. We retrospectively enrolled 109 patients with the diagnosis of CSP from our department and categorized them into four grades based on the ultrasound presentation. Grade I CSP indicated the GS embedded in less than one-half thickness of the lower anterior corpus; and grade II CSP represented the GS extended to more than one-half thickness of overlying myometrium. Grade III CSP implied the GS bulged out of the cesarean scar; and grade IV CSP denoted that GS became an amorphous tumor with rich vascularity at the cesarean scar. Seventy-eight women received surgery, and the complication rate was 14.1% (11/78). Linear regression analysis demonstrated a significant association between the invasiveness of the surgery and their ultrasound gradings. The mainstream operation for grade I CSP was transcervical resection, while the majority of grade III and IV patients required hysterotomy or hysterectomy. Another 31 women received chemotherapy with methotrexate as their initial treatment. The success rate for chemotherapy was 61.3%; the remaining patients required further surgery due to persistent CSP or heavy bleeding during or after chemotherapy. Fifteen patients (48.3%) receiving chemotherapy suffered from complications (mostly bleeding). Among them, 7 (22.6%) patients experienced bleeding of more than 1,000 mL, and 9 (29.0%) of these 31 patients required blood transfusions. Our novel ultrasound grading system for CSP may help to communicate between physicians, and determine the optimal surgical strategy. Chemotherapy with methotrexate for CSP is not satisfactory and is associated with a higher rate of complications.

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Section: Discussionmentioning

confidence: 99%