Bilateral uterine artery chemoembolization with methotrexate for cesarean scar pregnancy

Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, People's Republic of China.
American journal of obstetrics and gynecology (Impact Factor: 4.7). 11/2012; 207(5):386.e1-6. DOI: 10.1016/j.ajog.2012.09.012
Source: PubMed


The objective of the study was to assess the efficacy of uterine arteries embolization (UAE) for the treatment of cesarean scar pregnancies (CSP).
Forty-six women with CSP were identified between March 2008 and March 2010. All of the patients underwent UAE combined with local methotrexate.
Forty-five patients were successfully treated. One patient had an emergency hysterectomy after 20 days because of massive vaginal hemorrhage. The mean time until normalization of serum β-human chorionic gonadotrophin was 37.7 days, and the mean time until CSP mass disappearance was 33.3 days. The mean hospitalization time was 10.5 days. The complications were mainly fever and pain, which were alleviated with symptomatic treatment. All 45 patients had recovered their normal menstruation at follow-up.
Bilateral uterine artery chemoembolization with methotrexate appears to be a safe and effective treatment for CSP and causes less morbidity than current approaches.

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    • "Dans cette sé rie, les pertes sanguines n'e ´ taient cependant pas disponibles. L'A&C seule faisant suite a ` un retard ou dé faut de diagnostic initial, potentiellement hé morragique chez ces patientes, est a ` dé conseiller [30] [31]. En parallè le a ` la gestion des hé morragies du post-partum, l'utilisation de sonde a ` ballonnet permettant de façon mé canique un tamponnement intra-uté rin a e ´ té rapporté e avec succè s dans le traitement de GSC [32]. "
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    ABSTRACT: Implantation of a pregnancy within a cesarean delivery scar is considered to be the rarest form of ectopic pregnancy, with a high morbidity and mortality. Pregnancy in a cesarean delivery scar may cause catastrophic complications which may result in hysterectomy and compromise the reproductive future of a woman. We report an ectopic pregnancy in cesarean scar case in a 28-year old pregnant woman that was treated with success with the association between three treatment modalities (methotrexate, uterine artery embolization and curettage) and preserve her fertility.
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