Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jul;19(2):61-65.
doi: 10.5114/pm.2020.97836. Epub 2020 Jul 13.

Caesarean scar pregnancy: descriptive paper of three different types of management on a series of clinical cases

Ferdinando Antonio Gulino  1 , Elisa Pappalardo  1 , Carla Ettore  1 , Antonio Simone Laganà  2 , Stella Capriglione  3 , Giuseppe Ettore  1
Affiliations

Caesarean scar pregnancy: descriptive paper of three different types of management on a series of clinical cases

Ferdinando Antonio Gulino et al. Prz Menopauzalny. 2020 Jul.

Abstract

Introduction: A caesarean scar pregnancy is a complex iatrogenic pathology, which represents a consequence of a previous caesarean section. It increased in recent years due to parallel increase of cesarean sections.

Material and methods: We present a retrospective study on patients with caesarean scar pregnancy diagnosed in our department from June 2016 to June 2019. Stable women with an embryo (with or without cardiac activity) who accepted our experimental protocol were treated with single dose of methotrexate (50 mg administered locally intracavitary + 50 mg administered intramuscularly) and folinic acid (15 mg/day orally for 30 days). Clinically stable women with embryo (without cardiac activity) who decided to wait, were monitored by serial assays of b-hCG and clinical and ultrasonographic follow up. Women who were clinically unstable with embryo (without cardiac activity), were referred for urgent surgical treatment with dilation and curettage.

Results: Caesarean scar pregnancy was diagnosed in sixteen women. Among these women, seven were treated according to our experimental protocol with methotrexate and folinic acid and only one had profuse bleeding, which required a laparotomic hysterectomy. Four women were treated urgently with dilatation and curettage. Five women chose to wait: they were monitored and all spontaneously had a miscarriage.

Conclusions: In our preliminary study, we highlighted how our experimental protocol gave encouraging results in the first 10 weeks of caesarean scar pregnancy. However, caution is needed in patients with advanced gestational age, a gestational sac with large diameter, higher CRL and presence of embryonic cardiac activity.

Keywords: caesarean scar pregnancy; dilatation and curettage; expectant management; methotrexate; miscarriage.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflict of interest

Figures

Fig. 1
Fig. 1
Color flow of a scar pregnancy
Fig. 2
Fig. 2
Caesarean scar pregnancy with fetal activity
Fig. 3
Fig. 3
Caesarean scar pregnancy and crown-rump length
See this image and copyright information in PMC

References

    1. Timor-Tritsch IE, Khatib N, Monteagudo A, et al. . Cesarean Scar Pregnancies. J Ultrasound Med 2015; 34: 601-610. - PubMed
    1. Timor-Tritsch IE, Monteagudo A, Santos R, et al. . The diagnosis, treatment, and follow-up of cesarean scar pregnancy. Am J Obstet Gynecol 2012; 207: 44e1-e13. - PubMed
    1. Elson CJ, Salim R, Potdar N, et al. . on behalf of the Royal College of Obstetricians and Gynaecologists. Diagnosis and management of ectopic pregnancy. BJOG 2016; 123: e15-e55. - PubMed
    1. Bodur S, Özdamar O, Kiliç S, Gün I. The efficacy of the systemic methotrexate treatment in caesarean scar ectopic pregnancy: A quantitative review of English literature. J Obstet Gynaecol 2015; 35: 290-296. - PubMed
    1. Maheux-Lacroix S, Li F, Bujold E, et al. . Cesarean Scar Pregnancies: A Systematic Review of Treatment Options. J Minim Invasive Gynecol 2017; 21: 915-925. - PubMed

LinkOut - more resources