Caesarean Scar Ectopic Pregnancy: A Case Successfully Managed using Systemic Methotrexate and Suction and Evacuation

摘要

Caesarean Scar ectopic Pregnancy (CSP) is a rare type of ectopic pregnancy. But, its frequency has been increasing with increase in number of caesarean sections (C-section) performed worldwide. It is a form of ectopic pregnancy in which implantation occurs in the myometrium at the site of a previous caesarean scar. It can result in dreadful complications such as severe hemorrhage, uterine rupture and severe maternal morbidity. Thus, it becomes necessary to diagnose it at an early stage and also accurately to avoid complications and for preservation of future fertility. The recommendation is to therapeutically terminate the pregnancy at the time of diagnosis. Several types of conservative treatment modalities have been used: administration of methotrexate by local or systemic routes, dilatation and curettage, excising the trophoblastic tissue, ligation of hypogastric arteries bilaterally along with evacuation of trophoblastic tissue and selectively embolising the uterine artery followed by curettage with or without administration of Methotrexate (MTX). In this report, the author discusses a case of 38-year-old female patient of viable CSP which was managed successfully with combination of systemic MTX and subsequent suction and evacuation (S&E).