TITLE:
Cesarean Scar Pregnancy: A Report of 11 Cases and Review of the Literature Regarding Subsequent Pregnancy
AUTHORS:
Chiaki Heshiki, Keiko Mekaru, Maho Miyagi, Sugiko Oishi, Kozue Akamine, Hitoshi Sugiyama, Tadatsugu Kinjo, Hitoshi Masamoto, Yoichi Aoki
KEYWORDS:
Cesarean Scar Pregnancy, Methotrexate, Fertility Preservation
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.6 No.1,
January
11,
2016
ABSTRACT: Background: There is no consensus regarding the optimal treatment for
cesarean scar pregnancy (CSP) because treatment efficacy, safety, and the
influence on subsequent pregnancy must be taken into consideration. Here we
report our experience with 11 cases of CSP and review the literature regarding
subsequent pregnancy. Methods: Records of 11 CSP cases that were treated at our
hospital were retrospectively reviewed. CSP was treated by local methotrexate
(MTX) injection or laparotomic or laparoscopic removal of the gestational mass
and myometrial repair. Outcome of subsequent pregnancy after treatment was
followed-up until delivery. Results: Local MTX injection was performed for six
cases, laparotomic removal of the gestational mass and myometrial repair was
performed for two, and laparoscopic removal of the gestational mass and
myometrial repair was performed for three. The uterus was preserved in all
cases. After CSP treatment, eight pregnancies occurred in five cases, resulting
in six live births and two miscarriages. Conclusion: Advantages and
disadvantages of various treatment methods for CSP continue to be elucidated.
Serum hCG level, location of the gestational mass, thickness of the lower
uterine segment at the time of diagnosis, and whether the patient wishes for
fertility preservation should be considered when choosing a treatment plan.