Recurrent Cesarean Scar Ectopic Pregnancy Treated with Systemic Methotrexate

Ndubizu, Chima; McLaren, Rodney; McCalla, Sandra; Irani, Mohamad

doi:10.1155/2017/9536869

Cited by 5 publications

(6 citation statements)

References 19 publications

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“…This is extremely rare. Only few cases have been described in the literature (21)(22)(23). Unfortunately, no information regarding her treatment during this episode is available.…”

Section: Resultsmentioning

confidence: 99%

Experience With Medical Treatment of Cesarean Scar Ectopic Pregnancy (CSEP) With Local Ultrasound-Guided Injection of Methotrexate

et al. 2020

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Objective: Ectopic pregnancy within Cesarean section scars is a rare condition. Late diagnosis carries significant risk of bleeding with poor prognosis for survival. There is no consensus on the management of this type of pregnancy. Historically, our facility offered an intra-muscular injection of methotrexate that resulted in a significant failure rate and later need for surgery. We hypothesized that injecting methotrexate directly into the gestational sac would improve the success rate of the treatment.Patients and Methods: This retrospective, uni-centric study examined nine patients aged between 33 and 42 years (mean age = 36.5 years) with Cesarean scar ectopic pregnancy (CSEP) between 2010 and 2018. CSEP was diagnosed by transvaginal ultrasound at a mean gestational age of 8w0/7. CSEP was treated under general anesthetic by ultrasound-guided methotrexate injection directly into the gestational sac. HCG levels and subsequent childbearing were monitored post-treatment.Results: Half of the patients were asymptomatic at the time of diagnosis. All patients tolerated treatment well and all ectopic pregnancies were successfully removed. HCG levels returned to negative within 3 months without additional medical or surgical intervention. The post-treatment pregnancy rate was 50%. Discussions/Conclusions: Our findings indicate that local ultrasound-guided injection of methotrexate into the gestational sac is a safe and effective therapeutic approach when performed by a trained team on a hemodynamically stable patient in the early stages of CSEP.

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“…This is extremely rare. Only few cases have been described in the literature (21)(22)(23). Unfortunately, no information regarding her treatment during this episode is available.…”

Section: Resultsmentioning

confidence: 99%

Experience With Medical Treatment of Cesarean Scar Ectopic Pregnancy (CSEP) With Local Ultrasound-Guided Injection of Methotrexate

et al. 2020

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“…There is little scientific data on the risk of recurrence of the condition in future pregnancy, the role of the interval between the previous caesarean delivery and re-occurrence of caesarean scar pregnancy [7,46]. Few published studies have reported on the low risks or recurrence of SCP, suggesting that implantation into the CS scar is more likely a chance event, than the result of an affinity of a pregnancy for implanting into the scar [47].…”

Section: Discussionmentioning

confidence: 99%

Combination of medical and surgical management in successful treatment of caesarean scar pregnancy: a case report series

Pristavu

Vinturache

Mihălceanu

et al. 2020

BMC Pregnancy Childbirth

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Background There is no clear consensus on the management of caesarean scar pregnancy (CSP), a complex and life-threatening condition. The objective of this study was to present a novel approach to management of CSP that combines medical therapy of multidose methotrexate and mifepristone with active surgical management by uterine curettage and consecutive local haemostasis. Case presentation We report on a prospective case series of six women with first trimester pregnancy, in whom the diagnosis of CSP was confirmed by 2D and color Doppler transvaginal ultrasound and serial hormone chorionic gonadotropin (hCG) testing. Women were between 23 and 36 years old and had at least one previous delivery by caesarean. At admission, gestational age ranged between 6 to 14 weeks, and serum hCG levels between 397 and 23,000 mUI/ml. Upon decision of pregnancy termination, medical management was undertaken in all cases and 1 mg/kg systemic Methotrexate was administered between 1 and 5 daily doses. Mifepristone was part of the treatment in cases with live pregnancy. Surgical management was employed for the cases were an embryo was seen by ultrasound, being prompted by inadequate response to Methotrexate and/or signs of miscarriage with vaginal bleeding. Curettage combined with local isthmic balloon or vaginal pack tamponade prevented further complications. High treatment rates with preservation of fertility was achieved in all patients except one who underwent hysterectomy for invasive placentation. Ultrasound and hCG levels surveillance ensured that the resolution of pregnancy was achieved. Conclusion Women with history of delivery by caesarean section should be carefully monitored in future pregnancies for prompt diagnosis of CSP. Early diagnosis of CSP allows selection of successful conservative therapy. Through this case series we contribute with our experience to the body of knowledge about the management of this serious complication of early pregnancy.

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“…In conclusion, our data show that, among women with a prior CSP, the recurrence rate is higher than previously suspected based upon mostly single‐case reports or series with few cases 5,23–25 . This information should be incorporated into the initial counseling of women presenting with CSP, regardless of their future obstetric plans, in order that they understand realistically the outcome of any future pregnancy.…”

Section: Discussionmentioning

confidence: 65%

“…Based on these 17 studies, there were 1743 diagnoses of CSP. Sixteen of these studies (including 1643 diagnoses We found a further four articles reporting single, recurrent CSP cases 5,[23][24][25] , but these were not included in Table 3 due to a lack of pertinent data which made it impossible to include them in the statistical analysis.…”

Section: Resultsmentioning

confidence: 99%

Recurrent Cesarean scar pregnancy: case series and literature review

Timor‐Tritsch

Horwitz

D’Antonio

et al. 2021

Ultrasound in Obstet & Gyne

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Objectives To determine the rate of recurrent Cesarean scar pregnancy (CSP) in our clinical practices and to evaluate whether the mode of treatment of a CSP is associated with the risk of recurrent CSP, as well as to review the published literature on recurrent CSP. Methods We performed a retrospective search of our six obstetric and gynecological departmental ultrasound databases for all CSPs and recurrent CSPs between 2010 and 2019. We extracted various data, including number of CSPs with follow‐up, number of cases attempting and number achieving pregnancy following treatment of CSP and number of recurrent CSPs, as well as details of the treatment of the original CSP. After analyzing the clinical data, we evaluated whether the mode of treatment terminating the previous CSP was associated with the risk of recurrent CSP. We also performed a PubMed search for: ‘recurrent Cesarean scar pregnancy’ and ‘recurrent Cesarean scar ectopic pregnancy’. Articles were reviewed for year of publication, and extraction and analysis of the same data as those obtained from our departmental databases were performed. Results Our database search identified 252 cases of CSP. The overall rate of clinical follow‐up ranged between 71.4% and 100%, according to treatment site (mean, 90.9%). Among these, 105 women had another pregnancy after treatment of the previous CSP. Of these, 36 (34.3%) pregnancies were recurrent CSP, with 27 women having a single recurrence and three women having multiple recurrences, one with two, one with three and one with four. We did not find any particular single or combination treatment mode terminating the previous CSP to be associated with recurrent CSP. The literature search identified 17 articles that yielded sufficient information for us to evaluate their reported prevalence of recurrent CSP. These reported 1743 primary diagnoses of CSP, of which 944 had reliable follow‐up. Data were available for 489 cases that attempted to conceive again after treatment of a previous CSP, and on the 327 pregnancies achieved. Of these, 67 (20.5%) were recurrent CSP. Conclusions On the basis of our pooled clinical data and review of the literature, recurrent CSP is apparently more common than was previously assumed based upon mostly single‐case reports or series with few cases. This should be borne in mind when counseling patients undergoing treatment for CSP regarding their risk of recurrence. We found no obvious causal relationship or association between the type of treatment of the previous CSP and recurrence of CSP. Patients who become pregnant after treatment of a CSP should be encouraged to have an early (5–7‐week) first‐trimester transvaginal scan to determine the location of the gestation. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

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Recurrent Cesarean Scar Ectopic Pregnancy Treated with Systemic Methotrexate

Cited by 5 publications

References 19 publications

Experience With Medical Treatment of Cesarean Scar Ectopic Pregnancy (CSEP) With Local Ultrasound-Guided Injection of Methotrexate

Experience With Medical Treatment of Cesarean Scar Ectopic Pregnancy (CSEP) With Local Ultrasound-Guided Injection of Methotrexate

Combination of medical and surgical management in successful treatment of caesarean scar pregnancy: a case report series

Recurrent Cesarean scar pregnancy: case series and literature review

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