Medical Management of Cesarean Scar Pregnancy at Latifa Hospital Dubai Health Authority, Dubai, UAE

摘要

Introduction : Cesarean scar pregnancy (CSP) is defined as implantation of gestationalsac at the site of cesarean scar. It’s aserious diagnosis that has become more prevalent in recent years and related to the increasingrate of cesarean sections reported worldwide. Identifying these cases andtreating them is challenging, with no agreed upon universal protocol forsuccessful treatment. We aim to evaluatethe success rate and outcome of medical management for Cesarean scar pregnancy. Methods: It was a retrospective descriptive study of all cesarean scarpregnancies managed at fetal medicine unit at Latifa Hospital in Dubai, UAE themain obstetricsandGynecology tertiary hospital in Dubai Emirate, UAE from 2015 to 2017. Certainly, a setof diagnostic criteria were implemented to confirm the diagnosis of CSP. The cases were then offeredour proposed management which is systemic methotrexate injections ± KCL. Followup made by serial β hcg and ultrasoundscan. The data were collected used specified data collection sheet for this purposethen analyzed and presented using statistical package for social sciences(SPSS) version 26. Results : 33 cases of cesarean scar pregnancies areconfirmed and medically managed during the study period. The study subjectscomposed of a group of patients who had a viable CSP and received local KCLinjection + systemic methotrexate, a second group who had non-viable CSP andreceived systemic methotrexate 20 cases were viable pregnancies who received combinedlocal potassium chloride plus systemic methotrexate, and 13 were non-viablereceived systemic methotrexate only. The mean gestational age at diagnosis was8 weeks (SD ± 1.8). On average our cases had a history of 3 previous cesareansections (range 1 - 6). Overall, the success rate calculated from our studypopulation for medical management of CSP was 77.8%; this varied between viableCSP which had a success rate of 66.7% and non-viable CSP which had a successrate of 100%. The average period of outpatient follow-up for the patients toachieve complete resolution was 14 weeks (SD ± 7.5). Conclusions: Medicalmanagement of CSP in the form of systemic methotrexate ± local KCL injectionsproves to have acceptability and a good success rate especially for non-viableCSP, low complications rate and with the benefit of preserving futurefertility.