Bilateral uterine artery chemoembolization with methotrexate for cesarean scar pregnancy

Scar Ectopic Pregnancy

“…Diagnosis depends on symptoms, clinical manifestation, history of previous scar, serum bhCG level trasvaginal sonography (TVS). TVS diagnosis includes (1) an empty uterine cavity and cervical canal, (2) an gestational sac located at the anterior wall of the isthmic portion, separated from endometrial cavity or fallopian tube in previous caesarean scar, (3) a gestational sac embedded within the myometrium and the fibrous tissue of caesarean section scar at the lower uterine segment with an absence of defect in the myometrium between the bladder and the sac and (4) a high-velocity low-impedance vascular flow surrounds the gestational sac [4,9]. However, it is difficult to differentiate scar ectopic pregnancy from anterior cervical ectopic pregnancy, inevitable abortion or a cervicoisthmic pregnancy [10].…”

“…In 2012, Shen et al [4] reported that in their series of 45 patients with scar pregnancies 21 patients were initially misdiagnosed with spontaneous abortion or cervicoisthmic pregnancy. In cervical pregnancy, on ultrasonography (USG), uterus is empty with an endometrial stripe and the gestational sac is seen in cervix giving an hour glass shape to the uterus with ballooned cervical canal.…”

“…In 2012, Shen et al [4] reported that 45 patients were successfully treated with uterine artery embolization combined with local methotrexate. One patient had massive vaginal bleeding after 20 days of treatment which required emergency hysterectomy.…”

“…The incidence of CS ectopic pregnancy varies from 1:1800 to 2216 pregnancies with rate of 0.15 % in women with previous caesarean section and 6.1 % of all ectopic pregnancies [2,3]. In 2012, Shen et al [4], in their series of 45 patients with CS ectopic pregnancies, in which 42 women (93.3 %) had undergone only one caesarean section, concluded that multiple caesarean sections may not increase the risk of this condition. Similarly, systemic review found that scar ectopic pregnancy occurred in 52 % of cases following prior one caesarean section, 36 % in prior two caesarean section and 12 % after three or more prior caesarean section [5].…”

Tratamento conservador da gravidez ectópica em cicatriz de cesárea: relato de caso

“…Dentre elas podemos incluir a administração local ou sistêmica de metotrexato, curetagem uterina, histeroscopia, laparoscopia ou laparotomia para retirada do tecido ectópico e embolização de artéria uterina 10,14,15 .…”