Cesarean scar pregnancy: scope for hysteroscopy

Authors

  • Nitin H. Shah Department of Obstetrics and Gynecology, Aastha Maternity and Nursing Home, Mumbai, Maharashtra, India
  • Aditi V. Joshi Department of Obstetrics and Gynecology, Aastha Maternity and Nursing Home, Mumbai, Maharashtra, India
  • Renu Agrawal Department of Obstetrics and Gynecology, Aastha Maternity and Nursing Home, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20191985

Keywords:

Cesarean scar pregnancy, Hysteroscopy, Methotrexate

Abstract

Scar ectopic pregnancy also known as cesarean scar pregnancy is a rare form of an extrauterine pregnancy. The blastocyst is implanted at the site of the previous cesarean scar. Most patients remain asymptomatic and are detected on routine ultrasonography imaging. The diagnosis and management of this condition is hence challenging and difficult. A timely ultrasonography in the early weeks of gestation is the key to preventing catastrophic events like uterine perforation and excessive hemorrhage. There is a wide armamentarium of treatment modalities to choose from, however each case must be individualised. Medical management has its own limitations and often patients are required to have a long-term follow-up. We present a case of a cesarean scar pregnancy managed conservatively with systemic methotrexate but subsequently requiring surgical intervention done successfully via hysteroscopy. A repeat ultrasonography done a fortnight later revealed no retained products of conception.

References

Herman A, Weinraub Z, Avrech O, Maymon R, Ron-El R, Bukovsky Y. Follow up and outcome of isthmic pregnancy located in a previous caesarean section scar. Br J Obst Gynaecol. 1995;102(10):839-41.

Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obst Gynecol. 2006;107(6):1373-81.

Lee CL, Wang CJ, Chao A, Yen CF, Soong YK. Laparoscopic management of an ectopic pregnancy in a previous caesarean section scar. Human Repro. 1999;14(5):1234-6.

Kirk E, Bourne T. Diagnosis of ectopic pregnancy with ultrasound. Best Pract Res Clin Obstet Gynaecol. 2009;23(4):501-8.

Yang XY, Yu H, Li KM, Chu YX, Zheng A. Uterine artery embolisation combined with local methotrexate for treatment of caesarean scar pregnancy. BJOG. 2010;117(8):990-6.

Seow KM, Hwang JL, Tsai YL, Huang LW, Lin YH, Hsieh BC. Subsequent pregnancy outcome after conservative treatment of a previous cesarean scar pregnancy. Acta Obstet Gynecol Scand. 2004;83(12):1167-72.

Maymon R, Halperin R, Mendlovic S, Schneider D, Herman A. Ectopic pregnancies in a caesarean scar: review of the medical approach to an iatrogenic complication. Human Reproduct Update. 2004;10(6):515-23.

Vial Y, Petignat P, Hohlfeld P. Pregnancy in a cesarean scar. Ultrasound Obstet Gynecol. 2000;16(4):592-3

Lam PM, Lo KWK. Multiple-dose methotrexate for pregnancy in a cesarean section scar. A case report. J Reprod Med. 2002;47(4):332-4.

Goynumer G, Gokcen C, Senturk B. Treatment of a viable caesarean scar pregnancy with transvaginal methotrexate and potassium chloride injection. Arch Gynecol Obstet. 2009;280(5):869-72.

Godin PA, Bassil S, Donnez J. An ectopic pregnancy developing in a previous caesarian section scar. Fert Ster. 1997;67(2):398-400.

Downloads

Published

2019-04-29

Issue

Section

Case Reports