Medical Management of Cesarean Scar Pregnancy at Latifa Hospital Dubai Health Authority, Dubai, UAE

Abstract

Introduction: Cesarean scar pregnancy (CSP) is defined as implantation of gestational sac at the site of cesarean scar. It's a serious diagnosis that has become more prevalent in recent years and related to the increasing rate of cesarean sections reported worldwide. Identifying these cases and treating them is challenging, with no agreed upon universal protocol for successful treatment. We aim to evaluate the success rate and outcome of medical management for Cesarean scar pregnancy. Methods: It was a retrospective descriptive study of all cesarean scar pregnancies managed at fetal medicine unit at Latifa Hospital in Dubai, UAE the main obstetrics & Gynecology tertiary hospital in Dubai Emirate, UAE from 2015 to 2017. Certainly, a set of diagnostic criteria were implemented to confirm the diagnosis of CSP. The cases were then offered our proposed management which is systemic methotrexate injections ± KCL. Follow up made by serial βhcg and ultrasound scan. The data were collected used specified data collection sheet for this purpose then analyzed and presented using statistical package for social sciences (SPSS) version 26. Results: 33 cases of cesarean scar pregnancies are confirmed and medically managed during the study period. The study subjects composed of a group of patients who had a viable CSP and received local KCL injection + systemic methotrexate, a second group who had non-viable CSP and received systemic methotrexate 20 cases were viable pregnancies who received combined local potassium chloride plus systemic methotrexate, and 13 were non-viable received systemic methotrexate only. The mean gestational age at diagnosis was 8 weeks (SD ± 1.8). On average our cases had a history of 3 previous cesarean sections (range 1-6). Overall, the success rate calculated from our study population for medical management of CSP was 77.8%; this varied between viable CSP which had a success rate of 66.

Cesarean Scar Pregnancy: A Tertiary Care Center Experience

“…This was also suggested by Haimov-Kochman et al (10). Furthermore, Ammar et al demonstrated a 100% success rate for systemic MTX in their nonviable scar pregnancies (11).…”

“…Transvaginal fetal intracardiac injection of KCL was done in case 1 after failed initial systemic MTX. Ammar et al demonstrated in their study including 20 live scar pregnancies that administration of intra-gestational sac or intra-cardiac KCL combined with systemic MTX accomplished a success rate of 66.7%; the remaining cases required surgery for vaginal bleeding and one case developed sepsis (11). Our patient presented 4 days after the fetal intracardiac KCL injection with sepsis and then developed severe vaginal bleeding requiring emergency D&C. Upon presentation, leukopenia and neutropenia were evident; it is unclear if this was just a component of the sepsis or a side effect of MTX medication.…”

Comparison of diagnostic accuracy of three-dimensional transvaginal ultrasound and magnetic resonance imaging in the diagnosis of scar pregnancy

“…Endometrial vol-ume (EV 10 The gestational sac was implanted at the original surgical scar, some yolk sac, germ or cardiac tube pulsation can be seen, the echo of muscle layer near the gestational sac was relatively uniform, and circular blood flow signal could be seen. MRI findings of gestational sac scar pregnancy: 11,12 The gestational sac was attached to the surgical scar, and a round, long T1 and T2 signal shadow could be seen. Three-dimensional transvaginal ultrasound findings of mass scar pregnancy: there was no gestational sac echo in the cervical canal or uterine cavity, the gestational sac showed an uneven echo with a mixed mass, the boundary with the uterine myometrium was blurred, and blood flow signals appeared in and around the mass.…”