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

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Obstet Gynecol Sci > Volume 47(9); 2004 > Article

Original Article

Korean Journal of Obstetrics & Gynecology 2004;47(9):1743-1747.
Published online September 1, 2004.

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.

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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