Document Detail

Hysteroscopic management of cesarean scar ectopic pregnancy.
MedLine Citation:
PMID:  19342043     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To present our experience with hysteroscopic removal of cesarean scar ectopic pregnancy (CSP) and review the literature on the current management. DESIGN: Retrospective cohort study. SETTING: A tertiary referral university hospital, Sydney, Australia. PATIENT(S): Six patients diagnosed with CSP. INTERVENTION(S): Four patients were successfully treated with primary hysteroscopic removal of the ectopic pregnancy. Two patients were treated with systemic methotrexate (MTX), which failed; one patient had a subsequent hysteroscopic removal of CSP, and the second had local injection of MTX to the gestational sac. MAIN OUTCOME MEASURE(S): Clinical, serological, and ultrasound data and follow-up for subsequent pregnancies. RESULT(S): For the women treated surgically, the median time for the return of betahCG to <5 mIU/mL was 30 days, the mean operative time was 35 minutes, and the mean estimated blood loss was 140 mL. Three pregnancies were achieved: a miscarriage, a term pregnancy that resulted in a live birth, and an ongoing intrauterine pregnancy. The patient who was managed by MTX took 105 days for the betahCG to normalize and had an ongoing hematoma at the site of the CSP that took 247 days to resolve. CONCLUSION(S): Hysteroscopic management of CSP offers advantages over local injection with MTX and systemic MTX with a more rapid return to normal betahCG level and reduction in follow-up time.
Rebecca Deans; Jason Abbott
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Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2009-04-01
Journal Detail:
Title:  Fertility and sterility     Volume:  93     ISSN:  1556-5653     ISO Abbreviation:  Fertil. Steril.     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-03-30     Completed Date:  2010-04-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372772     Medline TA:  Fertil Steril     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1735-40     Citation Subset:  IM    
Copyright Information:
Crown Copyright 2010. Published by Elsevier Inc. All rights reserved.
Department of Endo-Gynaecology, Royal Hospital for Women, Randwick, New South Wales, Australia.
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MeSH Terms
Abortifacient Agents, Nonsteroidal / administration & dosage,  therapeutic use
Cesarean Section / adverse effects*
Cicatrix / complications*,  ultrasonography
Cohort Studies
Hysteroscopy / methods*
Injections, Intralesional
Methotrexate / administration & dosage,  therapeutic use
Pregnancy, Ectopic / etiology*,  surgery*,  ultrasonography
Retrospective Studies
Reg. No./Substance:
0/Abortifacient Agents, Nonsteroidal; 59-05-2/Methotrexate

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