Successful Treatment of Caesarean Scar Pregnancies by Local Treatment Only

Abstract EN

Background.

Caesarean scar pregnancy (CSP) is a rare ectopic pregnancy associated with life-threatening complications.

To date, no therapeutic protocols have been established.

Sono-guided local methotrexate (MTX) injection is a relatively easy and low-invasive treatment.

Additional systemic MTX is sometimes needed for CSP cases, especially when β-subunit human chorionic gonadotropin (β-hCG) levels are >20,000 mIU/ml at diagnosis.

We report on six cases of CSP treated with local MTX injection, five of which received combined local treatment.

Methods.

Under intravenous anesthesia, six CSPs including a case with β-hCG levels >20,000 mIU/ml received MTX injection to the gestational sac.

Five cases received gestational sac aspiration.

Three cases had additional local potassium chloride injection and one case had a saline injection aiming at the fetal heart beat concurrent with MTX injection.

MTX was administered weekly if β-hCG levels stayed beyond the expected values.

Outcomes.

All cases achieved β-hCG normalization without additional systemic MTX, with one case having a successful pregnancy after treatment.

Conclusion.

Sono-guided local MTX injection with concurrent local treatment might be a potentially effective approach for CSP cases.

The accumulation of further cases is necessary to confirm this.