Journal of Reproduction & Infertility

Journal of Reproduction & Infertility

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

Authors
Neena Malhotra 1
Nilofar Noor 1
Piyush Bansal 2
K. Aparna Sharma 1
1 Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
2 Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Nagpur, India
10.18502/jri.v22i3.6723
Abstract
Background: Cesarean section scar ectopic pregnancy (CSEP) is a rare and poten-tially 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
  1. No authors listed. Diagnosis and management of ectopic pregnancy: Green-top Guideline No. 21. BJOG. 2016;123(13):e15-55.
  2. Vial Y, Petignat P, Hohlfeld P. Pregnancy in a cesarean scar. Ultrasound. Obstet Gynecol. 2000;16(6):592-3.
  3. Larsen JV, Solomon MH. Pregnancy in a uterine scar sacculus--an unusual cause of postabortal haemorrhage. A case report. South Afr Med J Suid-Afr Tydskr Vir Geneeskd. 1978;53(4):142-3.
  4. Jayaram PM, Okunoye GO, Konje J. Caesarean scar ectopic pregnancy: diagnostic challenges and management options. Obstet Gynaecol. 2017;19(1):13-20.
  5. Qian ZD, Guo QY, Huang LL. Identifying risk factors for recurrent cesarean scar pregnancy: a case-control study. Fertil Steril. 2014;102(1):129-34.e1.
  6. Gonzalez N, Tulandi T. Cesarean scar pregnancy: a systematic review. J Minim Invasive Gynecol. 2017;24(5):731-8.
  7. Jayaram P, Okunoye G, Al Ibrahim AA, Ghani R, Kalache K. Expectant management of caesarean scar ectopic pregnancy: a systematic review. J Perinat Med. 2018;46(4):365-72.
  8. Seow KM, Wang PH, Huang LW, Hwang JL. Transvaginal sono-guided aspiration of gestational sac concurrent with a local methotrexate injection for the treatment of unruptured cesarean scar pregnancy. Arch Gynecol Obstet. 2013;288(2):361-6.
  9. Sadeghi H, Rutherford T, Rackow BW, Campbell KH, Duzyj CM, Guess MK, et al. Cesarean scar ectopic pregnancy: case series and review of the literature. Am J Perinatol. 2010;27(2):111-20.
  10. Cheung VYT. Local Methotrexate injection as the first-line treatment for cesarean scar pregnancy: review of the literature. J Minim Invasive Gynecol. 2015;22(5):753-8.
  11. Gupta M, Kriplani A, Mahey R, Kriplani I. Successful management of caesarean scar live ectopic pregnancies with local KCL and systemic methotrexate. BMJ Case Rep. 2017;2017:bcr 2017221844.
  12. Kaur R, Goel B, Sehgal A, Goyal P, Mehra R. Feticide with intracardiac potassium chloride to reduce risk of hemorrhage in medical termination of pregnancy. J Gynecol Women Healthc. 2018;1(1):1-4.
  13. Roy MM, Radfar F. Management of a viable cesarean scar pregnancy: a case report. Oman Med J. 2017;32(2):161-6.
  14. Deans R, Abbott J. Hysteroscopic management of cesarean scar ectopic pregnancy. Fertil Steril. 2010;93(6):1735-40.
  15. Ben Nagi J, Helmy S, Ofili-Yebovi D, Yazbek J, Sawyer E, Jurkovic D. Reproductive outcomes of women with a previous history of caesarean scar ectopic pregnancies. Hum Reprod. 2007;22(7):2012-5.
  16. Wang Q, Peng HL, He L, Zhao X. Reproductive outcomes after previous cesarean scar pregnancy: Follow up of 189 women. Taiwan J Obstet Gynecol. 2015;54(5):551-3.
Journal of Reproduction & Infertility
Volume 22, Issue 3
Summer 2021
Pages 220-224