Cesarean scar pregnancy: a systematic review of treatment studies

Petersen, Kathrine Birch; Hoffmann, Elise; Larsen, Claus; Nielsen, Henriette Svarre

doi:10.1016/j.fertnstert.2015.12.130

Cited by 322 publications

(372 citation statements)

References 77 publications

(106 reference statements)

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“…Birch Petersen et al reviewed 2037 CSP cases, noted complications in each treatment, and recommended five approaches: resection through a transvaginal approach, laparoscopy, uterine artery embolization (UAE) in combination with dilatation and curettage (D&C) and hysteroscopy, UAE in combination with D&C [3], and hysteroscopy. However, transvaginal sono-guided local methotrexate (MTX) injection was not recommended because of observed major complications and the need for additional systemic treatments [4].…”

Section: Introductionmentioning

confidence: 99%

Successful Treatment of Caesarean Scar Pregnancies by Local Treatment Only

Tanigaki

Nagata

Ueno

et al. 2017

Obstetrics and Gynecology International

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Background. Caesarean scar pregnancy (CSP) is a rare ectopic pregnancy associated with life-threatening complications. To date, no therapeutic protocols have been established. Sono-guided local methotrexate (MTX) injection is a relatively easy and low-invasive treatment. Additional systemic MTX is sometimes needed for CSP cases, especially when β-subunit human chorionic gonadotropin (β-hCG) levels are >20,000 mIU/ml at diagnosis. We report on six cases of CSP treated with local MTX injection, five of which received combined local treatment. Methods. Under intravenous anesthesia, six CSPs including a case with β-hCG levels >20,000 mIU/ml received MTX injection to the gestational sac. Five cases received gestational sac aspiration. Three cases had additional local potassium chloride injection and one case had a saline injection aiming at the fetal heart beat concurrent with MTX injection. MTX was administered weekly if β-hCG levels stayed beyond the expected values. Outcomes. All cases achieved β-hCG normalization without additional systemic MTX, with one case having a successful pregnancy after treatment. Conclusion. Sono-guided local MTX injection with concurrent local treatment might be a potentially effective approach for CSP cases. The accumulation of further cases is necessary to confirm this.

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Section: Introductionmentioning

confidence: 99%

Successful Treatment of Caesarean Scar Pregnancies by Local Treatment Only

Tanigaki

Nagata

Ueno

et al. 2017

Obstetrics and Gynecology International

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“…But, systemic methotrexate appears to be more effective in women with B-HCG level <5000 mU/mL according to the literature. 13,16 In our study all the patients had B-HCG levels <5000 mU/mI. In only 2 patients multidose (2 doses) were required.…”

Section: Discussionmentioning

confidence: 48%

Cesarean scar pregnancy: an upcoming challenge

Juneja

Tandon

Bhanupriya

2018

Int J Reprod Contracept Obstet Gynecol

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Background: Cesarean scar pregnancy (CSP) is a type of ectopic pregnancy implanted in the myometrium at the site of previous cesarean scar. Incidence of cesarean deliveries are increasing globally, leading to rise in incidence of cesarean scar pregnancy. Caesarean scar pregnancies are associated with some life-threatening complications such as scar rupture, haemorrhage, disseminated intravascular coagulation, requiring lifesaving hysterectomy. We present our experience with 11 patients with cesarean scar pregnancy, diagnosed using transvaginal colour doppler ultrasound during 3-year period and treated conservatively to preserve the uterus with successful outcome in all patients.Methods: This was a retrospective study, conducted in the Department of Obstetrics and Gynecology of DMC&H, Ludhiana from January 2015 to December 2017. Out of total deliveries (4278), 3.9% (171/4278) were diagnosed as ectopic pregnancy. 6.43% (11/171) of them were diagnosed as cesarean scar ectopic pregnancy. After counseling, all patients underwent conservative management. Injection methotrexate 50mg was administered intramuscularly and beta- HCG was monitored after 4 days and then weekly till it was <1.Results: 2 patients had an increase in beta HCG levels on day 7 and required second dose of methotraxate. 8 patients required blood transfusion due to excessive bleeding on admission. In 9 patients beta HCG levels reduced to <1 in 7 weeks post first methotraxate dose administration, and in remaining 3 it returned to <1 after 8 weeks . No patient required any surgical intervention.Conclusions: Cesarean scar pregnancy, a type of ectopic pregnancy can be safely managed conservatively if diagnosed early.

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“…Curettage after UAE is currently accepted as an effective treatment for CSP. UAE can accurately detect and embolize the uterine arteries for efficient reduction of bleeding risk during curettage [2, 17, 18]. However, UAE requires digital imaging equipment and such equipment are expensive.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Efficacy of Ultrasound-Guided Local Lauromacrogol Injection Combined with Aspiration for Cesarean Scar Pregnancy: A Novel Treatment

Chai

Liu

et al. 2017

Gynecol Obstet Invest

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Objectives: To evaluate the efficacy of ultrasound-guided local lauromacrogol injection combined with aspiration for treating cesarean scar pregnancy (CSP). Methods: From July 2016 to December 2016, 18 patients diagnosed with CSP were treated with ultrasound-guided local lauromacrogol injection combined with aspiration. Clinical data and outcome were analysed. Results: All patients were treated successfully. The amount of bleeding ranged between 10 and 50 mL. The duration of hospitalization ranged between 2 and 11 days. Serum β-human chorionic gonadotropin (β-hCG) decreased to the nondetectable level within 19–41 days. Menstruation recovery occurred after 10–24 days of normalization of serum β-hCG level. Reproductive functions were preserved, and there were no untoward effects or complications. Conclusions: Ultrasound-guided local lauromacrogol injection combined with aspiration is an effective CSP therapy, as it was associated with a high success rate, short hospitalization and fast recovery. However, its wider application and popularization have to be validated on a larger patient population affected by CSP.

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Cesarean scar pregnancy: a systematic review of treatment studies

Cited by 322 publications

References 77 publications

Successful Treatment of Caesarean Scar Pregnancies by Local Treatment Only

Successful Treatment of Caesarean Scar Pregnancies by Local Treatment Only

Cesarean scar pregnancy: an upcoming challenge

Evaluation of the Efficacy of Ultrasound-Guided Local Lauromacrogol Injection Combined with Aspiration for Cesarean Scar Pregnancy: A Novel Treatment

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