Conservative Management of Intramural Pregnancy Implanting in The Cesarean Section Scar

Kim, Hee Jin; Lee, Kyoung Soon; Han, Mee Young; Lee, Eun Hee; Choi, Won Young

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.