Abstract
Purpose
Our aim was to present our experience with the management of six women with uterine scar pregnancies in KK Women’s and Children’s Hospital, Singapore.
Methods
The medical records of women with a pregnancy in previous uterine scar that had been diagnosed in our department during 2004–2008 were reviewed.
Results
Out of six women, one woman presented in mid-trimester, at 16 weeks with severe abdominal pain and persistent vomiting. She underwent a hysterectomy complicated with massive haemorrhage. The other five women presented in first trimester. Two women had excision of the scar with the sac, two had ultrasound-guided injection of methotrexate in the sac and one had systemic methotrexate. In all cases, maternal recovery was complete. Uterine scar pregnancy was diagnosed by ultrasonography.
Conclusion
Women at a risk appear to be those with multiple Caesarean sections, termination of pregnancy and myomectomy. Operative as well as medical treatments have been reported for scar pregnancy. Surgical treatment includes excision of trophoblastic tissues by laparotomy or laparoscopy whilst medical treatment includes local and/or systemically administered methotrexate. Although many interventions have been described, optimal treatment is still not known and they remain a challenge.
References
Larsen JV, Solomon MH (1978) Pregnancy in a uterine scar sacculus—an unusual case of postabortal hemorrhage. A case report. S Afr Med J 28:142–143
Seow KM, Huang LW, Lin YH, Lin MY, Tsai YL, Hwang JL (2004) Cesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol 23:247–253
Sadeghi H, Rutherford T, Rackow BW, Campbell KH, Duzyj CM, Guess MK et al (2009) Cesarean scar ectopic pregnancy: case series and review of the literature. Am J Perinatol doi:10.1055/s-0029-1224874
Ash A, Smith A, Maxwell D (2007) Caesarean scar pregnancy. Br J Obstet Gynecol 114:253–263
Fylstra DL (2002) Ectopic pregnancy within a caesarean scar: a review. Obstet Gynecol Surv 57:431–537
Lee CL, Wang CJ, Chao A et al (1999) Laparoscopic management of an ectopic pregnancy in a caesarean section scar. Hum Reprod 14:1234–1236
Godin P-A, Bassil S, Donnez J (1997) An ectopic pregnancy developing in a previous caesarean section scar. Fertil Steril 67:398–400
Vial Y, Petignat P, Hohlfeld P (2000) Pregnancy in a caesarean scar. Ultrasound Obstet Gynecol 16:592–593
Chao A, Wang TH, Wang CJ et al (2005) Hysteroscopic management of caesarean scar pregnancy after unsuccessful methotrexate treatment. J Minim Invasive Gynecol 12:374–376
Ben Nagi J, Ofili-Yebovi D, Sawyer E, Aplin J, Jurkovic D (2006) Successful treatment of a recurrent caesarean scar ectopic pregnancy by surgical repair of the uterine defect. Ultrasound Obstet Gynecol 38:855–857
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Tagore, S., Wendy Teo, S.H., Irene Chua, S.Y. et al. A retrospective review of uterine scar pregnancies: single centre experience. Arch Gynecol Obstet 282, 711–715 (2010). https://doi.org/10.1007/s00404-010-1413-5
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DOI: https://doi.org/10.1007/s00404-010-1413-5