Abstract
Objective
Caesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy implanted in a
previous caesarean scar. Selective chemoembolization with methotrexate (SCEM) followed
by suction curettage (SC) is one of the treatment options for CSP. The aim of the
study was to assess the effectiveness, complications and reproductive outcome of SCEM
followed by SC in the treatment of CSP.
Study design
All cases of CSP treated with SCEM followed by SC between 2015 and 2018 were prospectively
followed-up to assess short and long-term outcome. All patients hospitalized with
the suspicion of CSP during the study period were included in the study. Gelatine
sponge was used as embolic material to avoid permanent damage of the uterus and minimise
the possible impact on fertility. Haemoglobin (Hb) and beta human chorionic gonadotropin
(β-hCG) levels, normalization of menstrual cycle, complications after the procedure
and subsequent fertility were assessed.
Results
Twenty-two patients diagnosed with CSP underwent SCEM followed by SC. The procedure
was effective in 20 cases (91%). In two cases additional SCEM was required before
attempting SC due to persistent vascularity on ultrasound in one case and abnormal
uterine bleeding in the second one. No complications were observed during the procedures,
none of the patients required a hysterectomy. Follow-up ranged from 9 to 36 months.
In short-term follow-up no significant complications occurred, only minor ailments
such as uterine cramping and nausea were reported by 8 patients. In long-term follow-up
8 patients reported at least one complication, such as hypomenorrhea, amenorrhoea
or were diagnosed with Asherman syndrome. Ten patients tried to conceive and 4 out
of them achieved a pregnancy (all in less than 12 months) and delivered by caesarean
sections between 35 and 39 weeks. One patient reported recurrent miscarriage.
Conclusion
SCEM followed by SC appears to be an effective treatment option for CSP. The method
seems to be safe in short-term follow-up. However, complications were observed in
long-term follow-up. Therefore, patients should be informed about the risk of complications
interfering with future fertility, such as intrauterine adhesions and/or amenorrhea.
Keywords
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Article info
Publication history
Published online: August 13, 2019
Accepted:
August 12,
2019
Received in revised form:
August 2,
2019
Received:
May 25,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
