Transvaginal sono-guided aspiration of gestational sac concurrent with a local methotrexate injection for the treatment of unruptured cesarean scar pregnancy.

Abstract

PURPOSE:

Cesarean scar pregnancy (CSP) is one of the rarest forms of ectopic pregnancy. A delay in treatment can lead to massive bleeding, uterine rupture, and life-threatening maternal morbidity. We present a conservative method for the management of CSP at a single tertiary centre over a 6-year period.

METHODS:

Eleven patients with unruptured CSPs who were treated by transvaginal aspiration of the gestational sac followed by a local methotrexate injection were evaluated.

RESULTS:

Gestational age at diagnosis ranged from 5 + 2 weeks to 7 + 4 weeks. Seven of the patients had undergone two prior Caesarean sections (63.6 %). The levels of β-hCG at the time of diagnosis ranged from 1,290 to 81,586 mIu/ml. The mean time of the procedure was 8.2 ± 1.6 min. During follow up, 54.5 % of the patients may need an additional systemic MTX injection due to an elevation of β-hCG. Estimated blood loss of the procedure was <50 ml and no blood transfusion is needed. This method has a shorter operative time, less blood loss and no hospitalization is needed for CSPs. All patients had their uterus successfully preserved without maternal morbidity or mortality.

CONCLUSIONS:

Transvaginal sono-guided sac aspiration concurrent with a local MTX injection is an effective management option for preserving the fertility of women with an unruptured CSP. However, additional systemic MTX injection may be needed if β-hCG levels >20,000 mIU/ml at diagnosis.

• Authors: Kok-Min Seow, Peng-Hui Wang, Lee-Wen Huang, Jiann-Loung Hwang
• Journal: Archives of gynecology and obstetrics (Arch Gynecol Obstet) Vol. 288 Issue 2 Pg. 361-6 (Aug 2013) ISSN: 1432-0711 [Electronic] Germany
• PMID: 23443605 (Publication Type: Journal Article)

Chemical References

• Abortifacient Agents, Nonsteroidal
• Chorionic Gonadotropin, beta Subunit, Human
• Methotrexate

Topics

• Abortifacient Agents, Nonsteroidal (therapeutic use)
• Adult
• Blood Loss, Surgical
• Cesarean Section (adverse effects)
• Chorionic Gonadotropin, beta Subunit, Human (blood)
• Cicatrix (complications)
• Female
• Gestational Age
• Humans
• Methotrexate (therapeutic use)
• Operative Time
• Pregnancy
• Pregnancy, Ectopic (blood, diagnostic imaging, therapy)
• Suction
• Ultrasonography, Interventional