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GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE
A Journal on Internal Medicine and Pharmacology
Indexed/Abstracted in: BIOSIS Previews, EMBASE, Scopus, Emerging Sources Citation Index
Gazzetta Medica Italiana Archivio per le Scienze Mediche 2011 October;170(5):359-64
Diagnostic and therapeutic management of Caesarean scar ectopic pregnancy. A case report
Kalogiannidis I., Petousis S., Margioula-Siarkou C., Tsaridis E., Prapas N.
Fourth Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
Caesarean scar pregnancy is a rare case of ectopic pregnancy in which the embryo is implanted in the myometrium of the scar of a previous caesarean section (CS). We report the diagnostic and therapeutic management of a first trimester caesarean scar pregnancy. A 38-year old woman presented on the 7th week of amenorrhea. Ultrasonography revealed a gestational sac located in the anterior uterus wall. A fetus with positive fetal cardiac activity was recognized, corresponding to 7 weeks (w) and 3 days (d) of gestation. Uterine cavity and endocervical canal were empty and the trophoblastic tissue was surrounded by healthy myometrium. The diagnosis of an ectopic pregnancy in the previous scar of CS was made. Although β-hCG levels at the time of diagnosis were high, the early diagnosis (7 w+3 d) triggered us to treat the pregnancy conservatively. An intramuscular injection of 65 mg (1 mg/kg) methotrexate (MTX) was performed on 7 w and 4 d. One week later, examination revealed a reduction of β-hCG (8 w+3 d). However, at the end of the following week (9 w+4 d), β-hCG was re-raised. The apparent failure of the conservative approach changed our management to the surgical removal of the gestational sac on 9 w+5 d. Histopathology examination confirmed the ectopic pregnancy. Five weeks later, β-hCG levels became null. Despite the plethora of medical and surgical therapeutic choices, no consensus has yet been established. However, conservative treatment may lead in failure, while laparotomy is a definite therapeutic method. Therefore, the persistent evaluation of patient is a high priority in the case of a conservative therapeutic approach.