Successful Conservative Treatment of a Cesarean Scar Pregnancy with Systemically Administered Methotrexate and Subsequent Dilatation and Curettage: A Case Report

Abstract

Cesarean scar pregnancy is a rare type of ectopic pregnancy associated with severe complications such as uterine rupture, uncontrollable bleeding which may lead to hysterectomy, and definitive infertility. Many therapeutic options are available such as Dilatation & Curetage, excision of trophoblastic tissues using either laparotomy or laparoscopy, systemically administered Methotrexate, and more recently uterine artery embolization. The use of Methotrexate sometimes required laparotomy later because of severe hemorrhage. Through this paper, we demonstrated that viable cesarean scar pregnancy can be managed safely by systemically delivered Methotrexate at the cost of a prolonged followup.

Clinical classification and treatment of cesarean scar pregnancy

“…Massive bleeding could happen at any time during the monitoring days. In contrast to some authors, we think SC without MTX saves time and money. On the other hand, we also favor direct SC over SC after UAE.…”

Caesarean scar pregnancy: a 10 case series

“…Conservative treatment can include: dilatation and curettage, excision of trophoblastic tissues (laparotomy or laparoscopy), local and/or systemic administration of methotrexate, bilateral hypogastric artery ligation associated with trophoblastic evacuation, and selective uterine artery embolization combined with curettage and/or MTX administration. 9 In this case series, two patients was treated conservatively. One patient received systematic MTX.…”

Caesarean scar pregnancy: a case report with review of management options

“…The use of dilation and curettage was dictated by the persistence of gestational sac despite negativity of β-hCG levels. 13 Some authors propose that dilation and curettage should not be the first line of management for scar pregnancy due to risk of perforation and catastrophic hemorrhage. 14 Hysteroscopic removal of CSP was done by Chou et al after failure of systemic methotrexate treatment.…”