Conservative Management of Intramural Pregnancy Implanting in The Cesarean Section Scar. |
Hee Jin Kim, Kyoung Soon Lee, Mee Young Han, Eun Hee Lee, Won Young Choi |
1Department of Obstetrics and Gynecology, Ilsin Christian Hospital, Busan, Korea. 2Department of Pathology, Ilsin Christian Hospital, Busan, Korea. |
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Abstract |
OBJECTIVE To evaluate of safety and effectiveness of conservative treatment of previous cesarean section scar pregnancy. METHODS: Ten patients with previous cesarean section scar pregnancy were treated systemic methotrexate or intra-amnionic methotrexate injection. After treatment, patients were measured for the levels of serum beta-hCG and underwent ultrasound. According to the results, additional dose of methotrexate or curettage were done. Serum beta-hCG and ultrasound were checked several times until the level of serum beta-hCG and the finding of ultrasound had been normalized. RESULTS: Two patients showed normal serum beta-hCG levels and ultrasound findings after intra-amnionic methotrexate injection only. Two patients showed normal serum beta-hCG levels and ultrasound findings after systemic methotrexate/folinic acid therapy followed by dilatation and curettage. Six patients showed normal serum beta-hCG levels and ultrasound findings after intra-amnionic methotrexate injection followed dilatation and curettage. Two patients were transfused due to massive bleeding and other patients were not experienced severe complications. CONCLUSION: These results suggest that systemic or intra-amnionic methotrexate therapy with or without dilatation and curettage is safe and effective as a primary therapy for intramural pregnancy implanting in the cesarean section scar. |
Key Words:
Ectopic pregnancy, Intramural pregnancy, Cesarean section scar, Methotrexate |
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