Management of Cesarean Scar Pregnancies: A Review of 20 Cases

Chelly S, Ben Rejeb O, Ernez S, Derouiche M and Boughizane S

1Department of Gynecology and Obstetrics, Farhat Hached University Hospital, Tunisia Ibn Al Jazzar, Sousse, University of Sousse, Tunisia

^*Correspondance to: Oumayma Ben Rejeb 

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Abstract:

Introduction: The aim of this study is to present the epidemiologic and clinical characteristics of our patients diagnosed with Cesarean Scar Pregnancy (CSP) and its management in our maternity. Methods: Descriptive, retrospective, monocentric study, in the maternity of the University Hospital Farhat Hached Sousse, Tunisia, from January 01st, 2010 to December 31st, 2019 (10 years), including 20 CSP cases. Results: The mean age was 34.85 years [23-43] and the mean number of previous cesarean sections was 2 [1-3]. The main reason for consultation was metrorrhagia in 40% of cases, pelvic pain in 10%, and 45% of cases were asymptomatic. The mean gestational age at diagnosis was 7.1 weeks [4.6- 12]. Mean anterior myometrial thinning was 3.81 mm [1.5-7.1]. First-line treatment was medical management with Intramuscular Methotrexate (IM MTX) in 9 cases (45%), a combination of IM MTX and in situ MTX in 9 cases (45%), ultrasound-guided curettage in 1 case (5%), and therapeutic abstinence in 1 case (5%). Second-line treatment included surgical management with Hysteroscopic Curettage (HSC), ultrasound-guided curettage, or a combination of HSC and curettage. Three patients who received medical treatment with IM MTX required second-line curettage. Eight patients who received a combination of IM MTX and in situ MTX required secondary treatment: 3 cases by curettage, 2 by operative HSC, and 3 by HSC and curettage. We had one case of death due to an allergic reaction to MTX presenting as severe toxidermia. Hemorrhagic complications occurred in five cases: 3 after curettage, 1 after IM MTX, and 1 after in situ MTX. No hysterectomy was required. Conclusion: Curettage treatment showed the highest rate of hemorrhagic complications (30%) due to perforation. Medical treatment only showed the longest recovery time (67 days), medical treatment followed by HSC and curettage was the safest group with no complications. Early diagnosis is essential to consider appropriate treatment. Several therapeutic algorithms have been proposed, but there is no real consensus.

Keywords:

Methotrexate; Ectopic pregnancy; Aspiration; Cesarean scar pregnancy

Cite the Article:

Chelly S, Ben Rejeb O, Ernez S, Derouiche M, Boughizane S. Management of Cesarean Scar Pregnancies: A Review of 20 Cases. World J Surg Surgical Res. 2024; 7: 1562..