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Case Reports
. 2021 Jul-Sep;22(3):220-224.
doi: 10.18502/jri.v22i3.6723.

Successful Management of Caesarean Scar Ectopic Pregnancies: A Report of Five Cases

Neena Malhotra  1 , Nilofar Noor  1 , Piyush Bansal  2 , K Aparna Sharma  1
Affiliations
Case Reports

Successful Management of Caesarean Scar Ectopic Pregnancies: A Report of Five Cases

Neena Malhotra et al. J Reprod Infertil. 2021 Jul-Sep.

Abstract

Background: Cesarean section scar ectopic pregnancy (CSEP) is a rare and potentially life-threatening condition. A standardized management protocol is yet to be established owing to limited data available.

Case presentation: In this paper, five cases of CSEP over a period of 18 months at a tertiary referral hospital, managed medically with methotrexate administered both systemically and into the gestational sac at the time of feticide with potassium chloride (KCL) are presented. Surgical management was the second line therapy when medical treatment failed.

Conclusion: With rising trends in cesarean deliveries, CSEP may be a challenge which requires close investigation regarding its diagnosis and treatment on the merits of case studies and available healthcare facilities.

Keywords: Caesarean section; Ectopic pregnancy; Gestational sac; Methotrexate.

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Conflict of interest statement

Conflict of Interest None.

Figures

Figure 1.
Figure 1.
Transvaginal ultrasound guided intrafetal injection of KCL and methotrexate instillation
Figure 2.
Figure 2.
Serial hCG trends in the 5 cases. Day 1 was the day of local/systemic methotrexate therapy at our center ↓ Indicates additional methotrexate doses * Indicates laparoscopic intervention
Figure 3.
Figure 3.
Color Doppler showing increased vascularity and MRI film showing anterior myometrial thickness <2 mm
Figure 4.
Figure 4.
Laparoscopic excision of caesarean scar ectopic pregnancy
Figure 5.
Figure 5.
2D and 3D USG view of the CSEP
Figure 6.
Figure 6.
Laparoscopic excision of 3cm caesarean scar ectopic mass
Figure 7.
Figure 7.
Ultrasound showing empty uterine cavity and endocervical canal. Ectopic pregnancy seen at the level of previous caesarean scar. Doppler study shows increased vascularity
Figure 8.
Figure 8.
A) Twin scar ectopic pregnancy. B) Complete resolution of scar ectopic mass on follow up scan
See this image and copyright information in PMC

References

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