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Multiple-dose methotrexate for pregnancy in a cesarean section scar. A case report
Po Mui Lam1, Keith Wing Kit Lo
1Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong. lampomui@cuhk.edu.hk
The Journal of Reproductive Medicine
|May 16, 2002
Summary
This study shows that methotrexate treatment can successfully manage pregnancy in a cesarean scar, a rare but dangerous condition. This non-surgical approach preserves the uterus and reduces risks associated with ectopic pregnancy.
Area of Science:
- Reproductive Medicine
- Gynecologic Surgery
- Medical Toxicology
Background:
- Pregnancy in a cesarean scar (CS-p) is a rare, life-threatening ectopic pregnancy.
- CS-p poses risks of uterine rupture and severe hemorrhage.
Observation:
- A 7-week gestation CS-p was diagnosed via transvaginal sonography.
- The gestational sac was implanted in the anterior isthmus with 3mm myometrium.
- The patient was asymptomatic and hemodynamically stable.
Findings:
- Two courses of systemic methotrexate-folinic acid were administered.
- The patient tolerated treatment, remaining stable.
- Serum hCG levels normalized (< 5 IU/L) by day 56.
Implications:
- Methotrexate offers a non-surgical option for CS-p, preserving uterine integrity.
- A multiple-dose methotrexate regimen provides rapid pregnancy interruption.
- Timely treatment is crucial to mitigate rupture and hemorrhage risks.