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. 2024 Nov 26;16(11):e74515.
doi: 10.7759/cureus.74515. eCollection 2024 Nov.

Management of Cesarean Scar Ectopic Pregnancies: A Retrospective Study and Literature Review

Reema Bhatt  1 , Anusmita Saha  1
Affiliations

Management of Cesarean Scar Ectopic Pregnancies: A Retrospective Study and Literature Review

Reema Bhatt et al. Cureus. .

Abstract

Cesarean scar ectopic pregnancy (CSEP) is localized over the scar of a previous cesarean section. CSEP is a challenging entity, both in terms of diagnosis and management. The clinical presentation of CSEP may vary from asymptomatic patients with positive urine pregnancy tests to acute presentations such as pelvic pain, bleeding per vaginum, uterine rupture, and hemodynamic instability. Cesarean scar ectopic pregnancy is primarily diagnosed by transvaginal ultrasound. We present a series of six cases of CSEPs, their diagnostic approaches, and outcomes. Out of our six cases, four patients underwent intracardiac injection of potassium chloride (KCl) followed by methotrexate instillation into the gestational sac. This led to the successful resolution of cardiac activity and the collapse of the gestational sac. Two patients underwent curettage under ultrasound guidance. All of the patients recovered successfully without any major surgery. The key to diagnosis is the high degree of suspicion of CSEP in cases of previous cesarean deliveries, even in the absence of any symptoms.

Keywords: cesarean scar pregnancy; ectopic pregnancy; intracardiac kcl; intrasac methotrexate; minimally invasive technique.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Ethics Committee, Amrita Hospital, Faridabad, Haryana issued approval AIMS-IEC-BAS-08-24-001. The Institutional Ethics Committee, Amrita Hospital, Faridabad, Haryana, approves the above-stated study to be conducted in its presented form. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. CSEP embedded in the myometrial scar defect (isthmocele)
CSEP: Cesarean scar ectopic pregnancy An original sample image from the study.
Figure 2
Figure 2. Sample images showing fetal pole and cardiac activity
(a) Cesarean scar ectopic pregnancy (CSEP) with the presence of fetal pole and (b) cardiac activity. Original images from the study.
Figure 3
Figure 3. Resolution of the gestational sac in two cases
(a) and (b) Resolution of the gestational sac (Gsac) following intracardiac instillation of KCl and intrasac methotrexate instillation, demonstrated in two different cases. Original images from the study.
Figure 4
Figure 4. Treatment approach and management of cesarean scar ectopic pregnancy
KCl: Potassium chloride, MTX: Methotrexate. Original treatment flowchart based on the study.
See this image and copyright information in PMC

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