Korean J Obstet Gynecol.  2012 Apr;55(4):274-277. 10.5468/KJOG.2012.55.4.274.

Successful conservative management of a viable Cesarean scar pregnancy: A case report

• Lee JE
• Choe SA
• Ku SY
• Kim SH
• Choi YM
• Kim JG
• Moon SY

• KMID: 1992626
• DOI: http://doi.org/10.5468/KJOG.2012.55.4.274

Abstract

Cesarean scar pregnancy is the one of the rarest forms of ectopic pregnancy and is associated with severe complications, such as uncontrollable bleeding and uterine rupture. However optimal treatment has not been established. We present here a case of ectopic pregnancy in the previous Cesarean scar treated successfully by uterine artery embolization in combination with subsequent intra-cardiac potassium chloride and intra-sac methotrexate injection without surgical or invasive intervention at 9+3 weeks' gestational age.

Keyword

Cesarean scar pregnancy; Potassium chloride; Methotrexate; Uterine artery embolization

MeSH Terms

Cicatrix
Female
Gestational Age
Hemorrhage
Methotrexate
Potassium Chloride
Pregnancy
Pregnancy, Ectopic
Uterine Artery Embolization
Uterine Rupture
Methotrexate
Potassium Chloride

Figure

• 

  Fig. 1 Transvaginal sonographic images of the Cesarean scar pregnancy showing (A) thinning of uterine myometrium at the anterior lower segment (arrow) and (B) normal fetal heart beat.

• 

  Fig. 2 Pelvis magnetic resonance imaging image shows severe thinning of uterine wall at the anterior lower segment (arrow).

Reference

1. Fylstra DL. Ectopic pregnancy within a cesarean scar: a review. Obstet Gynecol Surv. 2002. 57:537–543.

2. Ash A, Smith A, Maxwell D. Caesarean scar pregnancy. BJOG. 2007. 114:253–263.

3. Godin PA, Bassil S, Donnez J. An ectopic pregnancy developing in a previous caesarian section scar. Fertil Steril. 1997. 67:398–400.

4. Lee CL, Wang CJ, Chao A, Yen CF, Soong YK. Laparoscopic management of an ectopic pregnancy in a previous Caesarean section scar. Hum Reprod. 1999. 14:1234–1236.

5. Sugawara J, Senoo M, Chisaka H, Yaegashi N, Okamura K. Successful conservative treatment of a cesarean scar pregnancy with uterine artery embolization. Tohoku J Exp Med. 2005. 206:261–265.

6. Seow KM, Huang LW, Lin YH, Lin MY, Tsai YL, Hwang JL. Cesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol. 2004. 23:247–253.

7. Roberts H, Kohlenber C, Lanzarone V, Murray H. Ectopic pregnancy in lower segment uterine scar. Aust N Z J Obstet Gynaecol. 1998. 38:114–116.

8. Vial Y, Petignat P, Hohlfeld P. Pregnancy in a cesarean scar. Ultrasound Obstet Gynecol. 2000. 16:592–593.

9. Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson CJ. Cesarean scar pregnancy. Ultrasound Obstet Gynecol. 2003. 21:310.

10. Maymon R, Halperin R, Mendlovic S, Schneider D, Vaknin Z, Herman A, et al. Ectopic pregnancies in Caesarean section scars: the 8 year experience of one medical centre. Hum Reprod. 2004. 19:278–284.

11. Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson CJ. First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment Cesarean section scar. Ultrasound Obstet Gynecol. 2003. 21:220–227.

12. Ghezzi F, Lagana D, Franchi M, Fugazzola C, Bolis P. Conservative treatment by chemotherapy and uterine arteries embolization of a cesarean scar pregnancy. Eur J Obstet Gynecol Reprod Biol. 2002. 103:88–91.

13. Seok JM, Moon MJ, Chang SW, Lee YM, Jang JH, Baek MJ. Successful management of cesarean scar pregnancy at 13 weeks of gestation by uterine artery embolization: a case re port. Korean J Obstet Gynecol. 2010. 53:934–939.