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Cesarean Scar Pregnancy With Surgical and Conservative Managements: A Case Report
Banafsheh B Shoai1, Lauren Gibbs1, Regina Leonis1
1Obstetrics and Gynecology, Morehouse School of Medicine, Atlanta, USA.
Cureus
|July 1, 2024
Summary
Cesarean scar pregnancies (CSP) are rare ectopic pregnancies requiring prompt diagnosis and management to prevent uterine rupture and hemorrhage. Treatment varies based on fertility desires, with options ranging from hysterectomy to methotrexate or minimally invasive surgery.
Area of Science:
- Reproductive Medicine
- Gynecologic Surgery
- Maternal-Fetal Medicine
Background:
- Cesarean scar pregnancy (CSP) is a rare but dangerous form of ectopic pregnancy.
- High risk of uterine rupture and life-threatening hemorrhage necessitates prompt diagnosis and management.
- Existing literature describes various medical and surgical interventions for CSP.
Observation:
- Two cases of CSP diagnosed at an urban hospital in Atlanta, Georgia.
- Case 1: 30-year-old with 5 prior CS, opted for hysterectomy due to no future fertility desire.
- Case 2: 38-year-old with 3 prior CS, treated with methotrexate for CSP, desiring future fertility, resulting in successful resolution and subsequent intrauterine pregnancy.
Findings:
- Management decisions for CSP should incorporate patient's future fertility desires.
- Systemic intramuscular methotrexate (MTX) can be effective in resolving CSP in selected patients.
- Minimally invasive surgical approaches are recommended when surgical management is indicated.
Implications:
- A high index of suspicion is crucial for timely CSP diagnosis.
- Lack of prospective trials hinders consensus on optimal CSP management.
- Shared decision-making is vital for tailoring CSP treatment plans, balancing risks and fertility goals.
