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Transvaginal sono-guided aspiration of gestational sac concurrent with a local methotrexate injection for the treatment of unruptured cesarean scar pregnancy

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Cesarean scar pregnancy (CSP) is one of the rarest forms of ectopic pregnancy. A delay in treatment can lead to massive bleeding, uterine rupture, and life-threatening maternal morbidity. We present a conservative method for the management of CSP at a single tertiary centre over a 6-year period.

Methods

Eleven patients with unruptured CSPs who were treated by transvaginal aspiration of the gestational sac followed by a local methotrexate injection were evaluated.

Results

Gestational age at diagnosis ranged from 5 + 2 weeks to 7 + 4 weeks. Seven of the patients had undergone two prior Caesarean sections (63.6 %). The levels of β-hCG at the time of diagnosis ranged from 1,290 to 81,586 mIu/ml. The mean time of the procedure was 8.2 ± 1.6 min. During follow up, 54.5 % of the patients may need an additional systemic MTX injection due to an elevation of β-hCG. Estimated blood loss of the procedure was <50 ml and no blood transfusion is needed. This method has a shorter operative time, less blood loss and no hospitalization is needed for CSPs. All patients had their uterus successfully preserved without maternal morbidity or mortality.

Conclusions

Transvaginal sono-guided sac aspiration concurrent with a local MTX injection is an effective management option for preserving the fertility of women with an unruptured CSP. However, additional systemic MTX injection may be needed if β-hCG levels >20,000 mIU/ml at diagnosis.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Republic of China

    Kok-Min Seow, Lee-Wen Huang & Jiann-Loung Hwang

  2. Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Republic of China

    Kok-Min Seow & Peng-Hui Wang

  3. Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, 2, Section 2 Shih-Pai Road, Taipei, Taiwan, Republic of China

    Peng-Hui Wang

  4. School of Medicine, Fu-Jen Catholic University, Taipei Hsien, Republic of China

    Lee-Wen Huang

  5. Department of Obstetrics and Gynecology, Taipei Medical University, Taipei, Taiwan, Republic of China

    Jiann-Loung Hwang

Authors
  1. Kok-Min Seow
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  2. Peng-Hui Wang
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  3. Lee-Wen Huang
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  4. Jiann-Loung Hwang
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Correspondence to Peng-Hui Wang.

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Seow, KM., Wang, PH., Huang, LW. et al. Transvaginal sono-guided aspiration of gestational sac concurrent with a local methotrexate injection for the treatment of unruptured cesarean scar pregnancy. Arch Gynecol Obstet 288, 361–366 (2013). https://doi.org/10.1007/s00404-013-2765-4

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  • DOI: https://doi.org/10.1007/s00404-013-2765-4

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