Prevalence and Management Algorithm of Cesarean Section Scar Ectopic Pregnancies: A 9-year Experience

Article Type: Original Article
Authors: Natasha K Simula, Rahana Harjee, Mohamed A Bedaiwy, Nicole Todd


ABSTRACT:Objective: Cesarean scar ectopic pregnancies (CSPs) are rare but the incidence is increasing with increasing rates of cesarean deliveries. There is no consensus on management of CSPs with different medical and surgical treatments described in the literature. The aim of this study was to do a retrospective review on the management of the CSP cases at our institution to demonstrate that primary medical management is a safe option for both type 1 and type 2 CSPs.Methods: This is a retrospective case series of all patients diagnosed with a CSP at Vancouver General Hospital from January 2010 to September 2019. Patients were identified through the hospital medical records and a total of 403 charts were reviewed. Eleven patients with a CSP were identified, and data was collected on demographics, diagnosis and treatment outcomes. Ethical approval was obtained through the University of British Columbia Clinical Research Ethics Board (H18-03074).Results: All 11 patients had medical management as their initial management, except for one patient who had both methotrexate and adjunctive uterine artery embolization. Medical management was successful is all but 2 patients who required subsequent surgical management for persistent gestational sac and hCG. There were no cases of hemorrhage, blood transfusion, uterine rupture or need for hysterectomy.Conclusion: Medical management with multi-dose methotrexate, with intragestational KCl for patients presenting with a fetal heart rate, is a safe primary treatment modality for patients with both type 1 and type 2 CSP. Keywords: Ectopic pregnancy, methotrexate, cesarean section.

Issue Number: Issue - 3   September - December 2022
Pages: 97 - 138
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