Cesarean scar pregnancy
Conditions
Interventions
intramuscular methotrexate
Sponsors
hedi cheker hospital
Eligibility
Sex/Gender
Female
Inclusion criteria
Inclusion criteria: We included in our study all cases of CSP. The diagnosis of CSP was based on: ? A history of previous cesarean deliveries (CD). ? Positive -HCG levels in the serum ? Ultrasound criteria including: an empty uterine cavity and cervix, an absent or thin myometrium separating the gestational sac and/or placenta from the posterior wall of the bladder, a gestational sac and/or placenta located at the level of the previous uterine scar, and rich trophoblastic blood flow on the Doppler examination.
Exclusion criteria
Exclusion criteria: We did not include patients not previously diagnosed with CSP who presented at the emergency room with a complication such as a uterine rupture or uncontrolled hemorrhage.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The mean age was 33.5 years old. Most of patients (80%) reported history of 2 or more previous cesarean sections. The mean gestational age at diagnosis was 8 weeks. Patients presented mostly with isolated amenorrhea. The mean ßHCG serum level at admission was 52352.4 milliunits/mL. The diagnosis was made on ultrasonographic examination in all cases. The Management of CSP in group 1 was associated with a significantly shorter resolution time of serum ßHCG levels (p=0.006). A shorter hospital stay duration was also reported in group 1 but with no statistical significance (p=0.31). Complications were more observed in group 2 but with no statistical significance (p=0.61). | — |
Secondary
| Measure | Time frame |
|---|---|
| During the study, a total of 1753 cases of ectopic pregnancies were recorded. Among them, 20 patients diagnosed with CSP were included in the study. The mean age was 33.5 years old ±4.7. The mean gravidity was 4.5(±1.6) and the mean parity was 2.9(±1.5). The mean number of previous cesarean deliveries reported was 2.7(±1.3). Five subjects (25 %) reported undergoing at least one abortion, of which two patients (10%) were treated by dilatation and curettage (DC). CSP was diagnosed in twelve cases (60%) during an early ultrasonographic examination for isolated amenorrhea. Six patients (30%) presented with amenorrhea associated with vaginal bleeding, one patient (5%) with isolated vaginal bleeding and one patient (5%) with lower abdominal pain coupled with amenorrhea. The mean gestational age at diagnosis was 8 weeks (± 2 weeks). At the time of admission, 95 percent of the patients had normal vital signs. One patient (5%), with circulatory collapse, was admitted to the emergency room. Abdominal examination was normal in 95 % of the subjects, one patient (5%) had pelvic tenderness at initial abdominal exam. The gynecological examination showed mild vaginal bleeding in six cases (30%). The mean ßHCG serum level at admission was 52352.4 milliunits/mL (5910 milliunits/mL to 151326 milliunits/mL). The mean hemoglobin levels at admission were 11.8 g/dL (±1.5 g/dL). Eight patients (40 %) had anemia at the initial blood count. The CSP diagnosis was made in all patients using the ultrasonography criteria stated above. In terms of management strategies, 40% of patients underwent systemic MTX injection laparotomy, 55% underwent UAE associated with DC, and 5% were managed with systemic MTX associated with UAE and DC. The main complications reported after treatment were uterine rupture (5 %), circulatory collapse (5%) and incomplete uterine rupture (15 %). A transfusion was needed in two cases (10 %). | — |
Countries
Tunisia
Contacts
Public ContactOussema bardaa
resident
Outcome results
None listed