Introduction: The overall incidence of Cesarean scar pregnancy is increasing due to Cesarean rates. This
life-threatening condition has been historically managed in various ways as no single modality is reliable
enough. We report this case of live CSP managed initially with Fetocide followed by Methotrexate but
requiring Surgical management later on.
Presentation: A 32 years old para 5 with four previous Cesarean sections was diagnosed with live CSP.
HCG level was 76,619. The initial management was fetocide with KCL followed by Methotrexate. The
treatment was considered successful in view of appropriate reduction in serum HCG levels. The woman
required surgical management 10 weeks after the initial management, but the blood loss was minimal.
Discussion: A CSP may be asymptomatic or present with non-specific symptoms. The rate of initial
misdiagnosis is as high as 76%. TVUSS enables correct CSP diagnosis and implementation of minimally
invasive effective treatment. HCG levels can affect the overall outcome, but medical management can be
considered even with high HCG levels.
Conclusion: CSP is a life-threatening condition, therefore timely diagnosis and appropriate management is
crucial. Medical management can be considered in most cases even with high HCG, but management has
to be tailored according to the patient. Close follow up of patient after Medical treatment is important as
they may require further intervention.
Objectives: The use of Complementary and Alternative Medicine (CAM) by the general population andadmitted in hospitals has been on the increase. The study was carried to find out the prevalence of CAM useamong patients admitted in the tertiary care hospitals of Peshawar.Methods: This was a cross sectional study. The investigators administered a structured questionnaire to 400patients admitted in tertiary care hospitals of Peshawar. Data were analyzed using statistical package forsocial sciences version 13.0.Results: It was found that 189/400 (47.25%) patients had used CAM. There was association betweenchronic diseases and CAM. The association between illiteracy and CAM use was significant. There seemedto be a preference for use of Hakimi medicine over other forms of CAM being studied i.e. homeopathic,herbal, nutritional supplements. Most of the patients turned to CAM use on advice from their friends andfamily. Hence peer pressure was an important factor in increasing CAM use.Conclusion: In conclusion, CAM use is prevalent in our in-hospital population, and its undisclosed use canhave important medical and peri-operativeImplications.Keywords: CAM Use, Patients, Tertiary Care Hospitals, Prevalence.
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