Assessment of Transvaginal Hysterotomy Combined With Medication for Cesarean Scar Ectopic Pregnancy

Lower uterine segment pregnancy (Cesarean Scar Pregnancy and early placenta accreta): A rising complication from cesarean section with possible and similar early ultrasound diagnoses and management

“…They reported no significant complications, a faster time to return to normal menstrual cycles and a rapid decline of b-HCG to normal than reported with the current techniques (13). They also combined methotrexate injection with transvaginal hysterotomy for improved results (12). This technique needs to be further evaluated for its safety and efficacy.…”

“…Shen et al found bilateral uterine artery chemoembolization and local methotrexate injection to be a safe and effective treatment for cesarean scar pregnancy, with minimal morbidity (7). Wang et al described a newer transvaginal approach in removal of ectopic tissue from the cesarean scar via transvaginal hysterotomy (12,13). They reported no significant complications, a faster time to return to normal menstrual cycles and a rapid decline of b-HCG to normal than reported with the current techniques (13).…”

Hysteroscopy and suction evacuation of cesarean scar pregnancies: A case report and review

“…Despite several large case series there is still no general consensus on the best treatment for cesarean scar ectopic pregnancy. Successful treatments that have been reported include laparotomy and laparoscopic hysterotomy with resection, hysteroscopic and suction curettage evacuation, systemically administered methotrexate, local intra‐sac‐administered methotrexate, potassium chloride, and hyperosmolar glucose, uterine artery embolization, and a combination of the above . Because the implantation is within a scar, theoretically with a compromised blood flow and less access to systemically administered medication, when medical treatment is selected, methotrexate injected locally into the pregnancy may be favored .…”

“…Successful treatments that have been reported include laparotomy and laparoscopic hysterotomy with resection, hysteroscopic and suction curettage evacuation, systemically administered methotrexate, local intra-sac-administered methotrexate, potassium chloride, and hyperosmolar glucose, uterine artery embolization, and a combination of the above. [2][3][4][5][17][18][19][20][21][22] Because the implantation is within a scar, theoretically with a compromised blood flow and less access to systemically administered medication, when medical treatment is selected, methotrexate injected locally into the pregnancy may be favored. 7,22 Although expectant management with delivery of a near-term, live-born infant has been reported in cesarean scar pregnancy, an emergent cesarean hysterectomy with massive blood loss threatened the mother's life.…”

Cesarean Scar Pregnancy: Some Management Options

“…Transvaginal hysterotomy along with MTX injection [21] during the operation was used as treatment for 12 cases of CSP. The authors felt that the safety and efficacy of this method needed further confirmation.…”