TITLE:
Medical Management of Cesarean Scar Pregnancy at Latifa Hospital Dubai Health Authority, Dubai, UAE
AUTHORS:
A. Ammar, F. Nasrallah, H. Adan, J. Ali, M. Mussa, A. B. E. Fazari, N. Alsawalhee
KEYWORDS:
Caesarean Scar Pregnancy, Methotrexate, Potassium Chloride, Maternal Morbidity
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.10 No.4,
April
20,
2020
ABSTRACT: Introduction: Cesarean scar pregnancy (CSP) is defined as implantation of gestational
sac at the site of cesarean scar. It’s a
serious diagnosis that has become more prevalent in recent years and related to the increasing
rate of cesarean sections reported worldwide. Identifying these cases and
treating them is challenging, with no agreed upon universal protocol for
successful treatment. We aim to evaluate
the success rate and outcome of medical management for Cesarean scar pregnancy. Methods: It was a retrospective descriptive study of all cesarean scar
pregnancies managed at fetal medicine unit at Latifa Hospital in Dubai, UAE the
main obstetrics & Gynecology tertiary hospital in Dubai Emirate, UAE from 2015 to 2017. Certainly, a set
of diagnostic criteria were implemented to confirm the diagnosis of CSP. The cases were then offered
our proposed management which is systemic methotrexate injections ± KCL. Follow
up made by serial βhcg and ultrasound
scan. The data were collected used specified data collection sheet for this purpose
then analyzed and presented using statistical package for social sciences
(SPSS) version 26. Results: 33 cases of cesarean scar pregnancies are
confirmed and medically managed during the study period. The study subjects
composed of a group of patients who had a viable CSP and received local KCL
injection + systemic methotrexate, a second group who had non-viable CSP and
received systemic methotrexate 20 cases were viable pregnancies who received combined
local potassium chloride plus systemic methotrexate, and 13 were non-viable
received systemic methotrexate only. The mean gestational age at diagnosis was
8 weeks (SD ± 1.8). On average our cases had a history of 3 previous cesarean
sections (range 1 - 6). Overall, the success rate calculated from our study
population for medical management of CSP was 77.8%; this varied between viable
CSP which had a success rate of 66.7% and non-viable CSP which had a success
rate of 100%. The average period of outpatient follow-up for the patients to
achieve complete resolution was 14 weeks (SD ± 7.5). Conclusions: Medical
management of CSP in the form of systemic methotrexate ± local KCL injections
proves to have acceptability and a good success rate especially for non-viable
CSP, low complications rate and with the benefit of preserving future
fertility.