Document Detail

Multiple-dose methotrexate for pregnancy in a cesarean section scar. A case report.
MedLine Citation:
PMID:  12012889     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Pregnancy developing in a cesarean section scar is a very rare but possibly life-threatening condition because of the risk of rupture and excessive hemorrhage. CASE: A woman with previous cesarean section had transvaginal sonography performed at 7 weeks of gestation that showed a gestational sac implanted in the anterior isthmus wall of the uterus with 3 mm of myometrium between the sac and bladder wall. A diagnosis of pregnancy in the cesarean section scar was made. The patient was asymptomatic, and her hemodynamic condition was stable. Two courses of multiple-dose systemic methotrexate-folinic acid (1 mg/kg methotrexate intramuscularly on days 1, 3, 5 and 7 with 0.1 mg/kg folinic acid intramuscularly on days 2, 4, 6 and 8) were given. The patient tolerated it and remained stable during treatment. The serum hCG dropped to < 5 IU/L on day 56. CONCLUSION: Treatment with methotrexate is a non-surgical option that can improve preservation of the uterus in patients who desire fertility. A multiple-dose regimen causes rapid interruption of the pregnancy. This is very important because the risk of rupture and hemorrhage directly correlates with the duration of the pregnancy.
Po Mui Lam; Keith Wing Kit Lo
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  The Journal of reproductive medicine     Volume:  47     ISSN:  0024-7758     ISO Abbreviation:  J Reprod Med     Publication Date:  2002 Apr 
Date Detail:
Created Date:  2002-05-15     Completed Date:  2002-11-13     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0173343     Medline TA:  J Reprod Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  332-4     Citation Subset:  IM    
Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
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MeSH Terms
Abortifacient Agents, Nonsteroidal / administration & dosage*,  therapeutic use*
Cesarean Section / adverse effects*
Cicatrix / etiology*,  ultrasonography
Dose-Response Relationship, Drug
Methotrexate / administration & dosage*,  therapeutic use*
Pregnancy, Ectopic / drug therapy*,  ultrasonography
Reg. No./Substance:
0/Abortifacient Agents, Nonsteroidal; 59-05-2/Methotrexate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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