Cesarean scar pregnancy: Two case report and therapeutic management algorithm

Abstract

Objective: We aimed to present two cases of cesarean scar pregnancy (CSP) and a literature review to discuss their management.

Cases: We reported two cases of cesarean scar pregnancy (CSP) treated in Strasbourg's University Hospital between 2016 and 2018 and carried out an updated literature review concerning their treatment.

Results: The first case is a superficial implantation CSP managed by methotrexate (MTX) then ligation of the uterine arteries and echo-guided aspiration. The second case is a deep implantation CSP managed by MTX and then laparoscopic excision with clamping of the uterine arteries. In the literature, the most commonly used treatments are: MTX, echo-guided aspiration, and the combination of uterine artery embolization followed by echo-guided aspiration.

Conclusion: We established an algorithm in which CSP treatment by MTX can be considered alone if criteria are met. If not, surgery, chosen according to the depth of implantation, will be associated with MTX with a preventive hemostasis procedure by embolization or ligation of the uterine arteries.

Keywords: Algorithm of treatment; Cesarean scar pregnancy; Hemostatic procedure; Methotrexate; Surgery.