Successful Conservative Management of an Unruptured Cesarean Scar Ectopic Pregnancy

Nayak, Arun; Sarmalkar, Meenal; Mehendale, Madhuri; Singh, Neha; Dixit, Pratibha; Mistry, Shamlee

doi:10.1007/s13224-016-0892-0

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(2 citation statements)

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“…5 Hui Zhang et al described a transvaginal surgical excision of CSP after giving oral Mifepristone in some patients with high hCG values, in 25 cases of CSPII. 2 Arun Nayak et al have reported a successful management of CSP by bilateral uterine artery embolisation followed by D&C. 6 In our series, eight patients received systemic Methotrexate 50 mg one day prior to the planned intervention in an attempt to reduce bleeding. One patient received three doses of Methotrexate in an attempt to abolish the cardiac activity.…”

Section: Discussionmentioning

confidence: 75%

“…Different options tried are dilatation& curettage (D&C), hysteroscopy, laparoscopy/laparotomy and excision, hysterectomy, systemic and or local methotrexate, uterine artery embolisation followed by D&C, excision via vaginal route. 1,2,3,4,5,6 Rota et al in their review found expectant management in six cases led to rupture requiring hysterectomy in three women; D&C was associated with severe morbidity. Excision & repair was successful in 11 out of 12 cases.…”

Section: Discussionmentioning

confidence: 99%

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Caesarean Scar Pregnancy- The Experience in a Medical College in Government Sector

Mathews¹,

Sathi²

2017

jemds

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BACKGROUNDThe caesarean delivery (CD) rates are increasing worldwide. The CD rate in our hospital is around 32%. As CD rate increases the complications due to a caesarean delivery also increase. There is an increase in the serious and rare complication of caesarean delivery-that is caesarean scar pregnancy (CSP). This condition can present in a serious state if not detected early and can cause serious complications including hysterectomy which hampers a woman's future reproductive capacity. Hence, we decided to look into the details of CSP cases presenting in our hospital.The aim of our study was to discuss the clinical presentation, diagnosis and management of caesarean scar pregnancy cases admitted to the Department of Obstetrics and Gynaecology, during a period of two years from January 01, 2014 to December 31, 2016. MATERIALS AND METHODSA cross sectional study was conducted and all cases of CSP during the study period were included. The data were collected using a proforma by interviewing the patients and reviewing the medical records. RESULTSThere were 11 cases of CSP admitted during the study period. Mean gestational age at presentation was 8.96 ± 1.6 weeks. Most common symptom was painless bleeding which was present in 9 cases. 4 cases were referred due to excessive bleeding during curettage without suspecting CSP. 3 cases were diagnosed as CSP and referred. 7 patients received Methotrexate infusion intravenously one day before attempted evacuation or laparotomy. 1 patient received systemic Methotrexate alone. 5 patients received oral Mifepristone also one day prior to intervention. In 3 patients, re-evacuation was attempted and they had to undergo emergency laparotomy. In this study group, 8 patients had laparotomy, excision and repair and 2 patients had to undergo hysterectomy. CONCLUSIONHigh index of suspicion is to be maintained when women with prior caesarean delivery present with bleeding per vaginum and imaging should be done stressing on this aspect. In cases where CSP is diagnosed an early management should be ensued. Planned excision and repair can be helpful in reducing the morbidity of patients in low resource settings and conserving the reproductive potential of such women. KEYWORDSCaesarean Scar Pregnancy, Excision and Repair, Methotrexate, Mifepristone. HOW TO CITE THIS ARTICLE: Mathews D, Sathi MS. Caesarean scar pregnancy-the experience in a medical college in government sector.

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Section: Discussionmentioning

confidence: 75%