Conservative treatment of abnormally located intrauterine pregnancies (cervical and cesarean scar pregnancies): a multicenter analysis (Polish series)

Abstract

Conservative treatment should be the gold standard procedure in abnormally located intrauterine pregnancies. It is noticeable that MTX / KCl is more effective in a direct administration to the GS. In four cases, systemic MTX did not produce the desired effects. In these cases, the treatment was assisted by local administration of MTX or KCl, resulting in the termination of an abnormally located pregnancy.

Polish Society of Gynecologists and Obstetricians Guidelines for the application of hysteroscopy in gynecology

“…Indications for hysteroscopy may also include clinical situations in which uterine cavity, cervical canal and tubal ostia imaging is vital for the diagnostic and therapeutic management of the affected patients, e.g. treatment of symptomatic niche in the cesarean section scar, injection of methotrexate or other pharmacological agents into the gestational sac located in the cesarean section scar, diagnostic and/or operative hysteroscopy, with or without biopsy, before operative procedures in gynecology [8,9].…”

Practice guidelines of the Polish Society of Gynecologists and Obstetricians - Ultrasound Section for ultrasound screening in uncomplicated pregnancy - 2020

“…The purpose of the ultrasound examination before 10 weeks of pregnancy, performed on medical indications, is: a) image and location of the fertilized egg -confirmation of the presence of an intrauterine pregnancy or confirmation of a pregnancy with an unknown location. Special attention should be paid to the location of the gestational sac in patients after Caesarean sections due to the risk of pregnancy implantation in the scar after hysterotomy [3][4][5]. In case of any doubts in this respect, the patient should be referred for examination at the referral center.…”

Elective embryo or fetal reduction for caesarean scar pregnancy combined with intrauterine pregnancy

“…Treatment options for CSP should be based on the patient's condition and the surgeon's skill [3,17]. These treatments include surgical removal, hysteroscopic resection, and suction curettage [4][5][6][7][18][19][20][21]. Among them, a local KCl injection has been reportedly used to successfully treat CSP [20,22].…”