Incidence and outcomes of cases of caesarean scar ectopic pregnancy in a tertiary referral centre

Abstract

Background. Caesarean scar ectopic pregnancy (CSEP) is a rare condition in which the implantation of the gestational sac takes place within the uterine scar of a previous caesarean section (CS). If the pregnancy continues within the uterus, the risk of placenta accrete or uterine rupture is increased. Objective. To investigate four treatment methods, based on each patient’s clinical presentation, gestational age of the pregnancy and haemodynamic stability, for the management of CSEP. Methods. CSEP cases ( N =30) were diagnosed by ultrasound at the Shatby Maternity University Hospital, Egypt. Various treatment modalities, based on gestational age, were employed to treat the patients. Treatments included suction curettage ( n =12), embryo reduction with local methotrexate injection ( n =12), laparoscopic excision ( n =3) and excision through laparotomy ( n =3). Serum levels of beta-human chorionic gonadotrophin (β-hCG) were measured at diagnosis and weekly following treatment until the levels returned to non-pregnant values. Results. There was a significant positive correlation between gestational age in  weeks and the CSEP management strategy employed. β-hCG levels decreased from before treatment to the end of the follow-up period 3 weeks later. No cases required a hysterectomy, and no maternal complications were reported in this study. Conclusion. The appropriate CSEP management strategy varies according to gestational age. Suction and embryo reduction with local methotrexate injection offers an effective, safe and minimally invasive surgical treatment to remove ectopic pregnancy tissue. Closely monitored follow-up of patients, including serial measurement of β-hCG levels and ultrasonographic examinations, is recommended after CSEP management.