Combination of medical and surgical management in successful treatment of caesarean scar pregnancy: a case report series

Pristavu, Anda; Vinturache, Angela; Mihălceanu, Elena; Pintilie, R A; Onofriescu, Mircea; Socolov, Demetra

doi:10.1186/s12884-020-03237-8

Cited by 13 publications

(12 citation statements)

References 51 publications

(88 reference statements)

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“…The most common diagnosis techniques of CSP are abdominal ultrasonography, TVU, and color Doppler. The sensitivity of TVU is reported to be 84% [8]. In all women of this study, the size and location of the gestational sac was determined using TVU.…”

Section: Discussionmentioning

confidence: 95%

Cesarean scar pregnancy treatment: a case series

et al. 2021

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Background Cesarean scar pregnancy is a complicated and potentially life-threatening type of ectopic pregnancy. This study reports two women with cesarean scar pregnancy who were successfully treated with systemic methotrexate administration, and two other women who needed local re-administration of methotrexate after systemic injection. Case presentation Four Iranian pregnant women aged 29–34 years who were between 5 to 7 gestational weeks with cesarean scar pregnancy diagnosis are described. After a single dose of systemic methotrexate injection, the level of serum beta-human chorionic gonadotropin decreased in two of the women, while fetal activity was observed in the other two women. In the latter patients, methotrexate was injected under transvaginal ultrasound guidance into the gestational sac. As a result, the serum beta-human chorionic gonadotropin level first increased and then decreased in these patients. During the follow-up period, all the patients were stable and no complications were observed. Serum beta-human chorionic gonadotropin levels reached the non-pregnancy range from 4 to 9 weeks after treatment. Conclusion When diagnosed at early gestation, cesarean scar pregnancy can be treated successfully with methotrexate administration alone. The clinicians should be aware that the beta-human chorionic gonadotropin level may initially increase after methotrexate injection in some patients. However, the final outcome will be promising if the patients remain stable.

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Section: Discussionmentioning

confidence: 95%

Cesarean scar pregnancy treatment: a case series

et al. 2021

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“…Although several case studies have published treatment courses that include mifepristone for live pregnancies with CSP [10][11][12], there is one published retrospective analysis that includes a treatment arm including treatment with mifepristone, systemic methotrexate, and operative management which is most similar to the current case report [10]. Yu et al examined three different treatment arms in a retrospective analysis: mifepristone and operative management versus methotrexate and operative management versus mifepristone with methotrexate and operative management [10].…”

Section: Discussionmentioning

confidence: 99%

“…SMFM recommends against systemic methotrexate alone [2]. Mifepristone, which is used widely in conjunction with misoprostol for abortion management, is another medication that may be used in CSP in conjunction with other methods, although it was not described in the SMFM Consult series [10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Treatment of Recurrent Cesarean Scar Pregnancy With Oral Mifepristone, Systemic Methotrexate, and Ultrasound-Guided Suction Dilation and Curettage

Masten¹,

Alston²

2023

Cureus

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Cesarean scar pregnancy (CSP), or pregnancies with implantation in a prior cesarean section scar, are rare but may be becoming more common with an increase in cesarean section deliveries. History of prior CSP may also increase the risk for recurrent CSP. Several treatment options and combinations of treatment options for CSP have been described in the literature. Although the optimal treatment is unclear, the Society of Maternal-Fetal Medicine published recommendation guidelines, which include recommendations for the treatment/termination of CSP pregnancies. Treatment of CSP is recommended with operative resection, ultrasound-guided suction dilation and curettage (D&C), or intragestational methotrexate with or without treatment modalities. This is a case report of a patient with recurrent CSP. Her first CSP was incorrectly diagnosed as an incomplete abortion after unsuccessful treatment with misoprostol alone and ultimately was successfully treated with systemic methotrexate. Her second CSP is the basis of this case report and was successfully treated with oral mifepristone and systemic methotrexate (50 milligrams/meter 2 ) before an ultrasound-guided suction D&C at 10 weeks 1 day gestational age. The combination of mifepristone, systemic methotrexate, and suction D&C under ultrasound guidance as a treatment for recurrent CSP has not previously been described in published literature.

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“…Abnormal implantation of the pregnancy on a previous cesarean section scar ("cesarean scar pregnancy") is a gestational pathology increasingly diagnosed in association with rising rates of cesarean deliveries. The management of cesarean scar pregnancy is often tailored specifically to each patient according to the clinical presentation, β-HCG level, US findings, and desire for future pregnancies (8). Commonly, the management involves the combination of medical treatment with systemic and/or local methotrexate and surgical management with curettage, hysteroscopy, or abdominal/laparoscopic resection.…”

Section: Discussionmentioning

confidence: 99%