Taiwanese Journal of Obstetrics and Gynecology
Volume 44, Issue 2 , Pages 168-171, June 2005

Methotrexate Followed by Suctional Curettage: A Successful Treatment for Cesarean Scar Pregnancy

  • Yen-Yen Lim

      Affiliations

    • Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
  • ,
  • Chin-Yuan Hsu

      Affiliations

    • Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr. Chin-Yuan Hsu, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, 92, Section 2, Chung-Shan North Road, Taipei, Taiwan
  • ,
  • Chih-Ping Chen

      Affiliations

    • Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
    • National Yang-Ming University, Taipei, Taiwan

Received 23 July 2004; received in revised form 23 July 2004; accepted 23 July 2004.

Article Outline

Summary 

Objective

To report the conservative management of a patient with cesarean scar pregnancy.

Case Report

A 28-year-old woman, gravida 3, para 2, was initially diagnosed by transvaginal sonography to have a single viable gestation in a uterine scar. A single dose of systemic methotrexate 50 mg was given intramuscularly. A suctional curettage was then performed successfully. Serum levels of β-human chorionic gonadotropin returned to normal 21 days later. The patient had suffered from persistent vaginal spotting for 2 months, but no major complications were noted at follow-up.

Conclusion

To preserve fertility, systemic intramuscular methotrexate followed by suctional curettage may be a safe treatment alternative for cesarean scar pregnancies.

Key Words:  cesarean scar pregnancy , methotrexate , transvaginal ultrasonography

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References 

  1. Lai YM , Lee JD , Lee CH , Chen TC , Soong YK . An ectopic pregnancy embedded in the myometrium of a previous cesarean section scar . Acta Obstet Gynecol Scand . 1995;74:573–576
  2. Herman A , Weinraub Z , Avrech O , Maymon R , Ron-El R , Bukovsky Y . Follow up and outcome of isthmic pregnancy located in a previous cesarean section scar . Br J Obstet Gynaecol . 1995;102:839–841
  3. Hung TH , Jeng CJ , Yang YC , Wang KG , Lan CC . Treatment of cervical pregnancy with methotrexate . Int J Gynaecol Obstet . 1996;53:243–247
  4. Godin PA , Bassil S , Donnez J . An ectopic pregnancy developing in a previous cesarean section scar . Fertil Steril . 1997;67:398–400
  5. Fait G , Goyert G , Sundareson A , Pickens A . Intramural pregnancy with fetal survival: case history and discussion of etiologic factors . Obstet Gynecol . 1987;70:472–474
  6. Timor-Tritsch IE , Monteagudo A , Mandeville EO , Peisner DB , Anaya GP , Pirrone EC . Successful management of viable cervical pregnancy by local injection of methotrexate guided by transvaginal ultrasonography . Am J Obstet Gynecol . 1994;170:737–739
  7. Larsen JV , Solomon MH . Pregnancy in a uterine scar sacculus: an unusual cause of postabortal hemorrhage . South Afr Med J . 1978;53:142–143
  8. Ayoubi JM , Fanchin R , Meddoun M , Fernandez H , Pons JC . Conservative treatment of complicated cesarean scar pregnancy . Acta Obstet Gynecol Scand . 2001;80:469–470
  9. Shufaro Y , Nadjari M . Implantation of a gestational sac in a cesarean section scar . Fertil Steril . 2001;75:1217
  10. Ravhon A , Ben-Chetrit A , Rabinowitz R , Neuman M , Beller U . Successful methotrexate treatment of a viable pregnancy within a thin uterine scar . Br J Obstet Gynaecol . 1997;104:628–629
  11. Nawroth F , Foth D , Wilhelm L , Schmidt T , Warm M , Romer T . Conservative treatment of ectopic pregnancy in a cesarean section scar with methotrexate: a case report . Eur J Obstet Gynecol Reprod Biol . 2001;99:135–137
  12. Padavan P , Lauri F , Marchetti M . Intrauterine ectopic pregnancy: a case report . Clin Exp Obstet Gynecol . 1998;25:79–80
  13. Scaletta T , Kaplan BC . Ectopic pregnancy . N Engl J Med . 1994;330:713–714
  14. Van de Meerssche M , Verdonk P , Jacquemyn Y , Serreyn R , Gerris J . Cervical pregnancy: three case reports and a review of the literature . Hum Reprod . 1995;10:1850–1855
  15. Ginsburg KA , Quereshi F , Thomas M , Snowman B . Intramural ectopic pregnancy implanting in adenomyosis . Fertil Steril . 1989;51:354–356
  16. Hamilton CCM , Legarth J , Jaroudi KA . Intramural pregnancy after in vitro fertilization and embryo transfer . Fertil Steril . 1992;57:215–217
  17. Seow KM , Cheng WC , Chuang J , Lee C , Tsai YL , Hwang JL . Methotrexate for cesarean scar pregnancy after in vitro fertilization and embryo transfer. A case report . J Reprod Med . 2000;45:754–757
  18. Herman A , Weinraub Z , Avrech O , Maymon R , Ron-El R , Bukovsky Y . Follow up and outcome of isthmic pregnancy location in a previous cesarean section scar . Br J Obstet Gynaecol . 1995;102:839–841
  19. Huang KH , Lee CL , Wang CJ , Soong YK , Lee KF . Pregnancy in a previous cesarean scar: case report . Chang Gung Med J . 1998;21:323–327
  20. Valley MT , Pierce JG , Daniel TB , Kaunitz AM . Cesarean scar pregnancy: imaging and treatment with conservative surgery . Obstet Gynecol . 1998;91:838–840
  21. Marcus S , Cheng E , Goff B . Extrauterine pregnancy resulting from early uterine rupture . Obstet Gynecol . 1999;94:804–805
  22. Lee CL , Wang CJ , Chao A , Yen CF , Soong YK . Laparoscopic management of an ectopic pregnancy in a previous caesarean section scar . Hum Reprod . 1999;14:1234–1236
  23. Roberts H , Kohlenber C , Lanzarone V , Murray H . Ectopic pregnancy in lower segment uterine scar . Aust NZ J Obstet Gynecol . 1998;38:114–116
  24. Jurkovic D , Hacket F , Campbell S . Diagnosis and treatment of early cervical pregnancy: a review and report of two cases treated conservatively . Ultrasound Obstet Gynecol . 1996;8:373–380
  25. Lipscomb GH , Stovall TG , Ling FW . Nonsurgical treatment of ectopic pregnancy . N Engl J Med . 2000;343:1325–1329
  26. Kung FT , Chang SY . Efficacy of methotrexate treatment in viable and nonviable cervical pregnancies . Am J Obstet Gynecol . 1999;181:1438–1444
  27. Kochman RH , Tamir YS , Yanai N , Yagel S . Conservative management of two ectopic pregnancies implanted in previous uterine scars . Ultrasound Obstet Gynecol . 2002;19:616–619
  28. Timor-Tritsch IE , Monteagudo A , Matera C , Veit CR . Sonographic evaluation of cornual pregnancies treated without surgery . Obstet Gynecol . 1992;79:1044–1049

PII: S1028-4559(09)60132-7

doi:10.1016/S1028-4559(09)60132-7

Taiwanese Journal of Obstetrics and Gynecology
Volume 44, Issue 2 , Pages 168-171, June 2005