Successful Treatment of Caesarean Scar Pregnancies by Local Treatment Only
Background. Caesarean scar pregnancy (CSP) is a rare ectopic pregnancy associated with life-threatening complications. To date, no therapeutic protocols have been established. Sono-guided local methotrexate (MTX) injection is a relatively easy and low-invasive treatment. Additional systemic MTX is s...
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| Format: | Article |
| Language: | English |
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Wiley
2017-01-01
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| Series: | Obstetrics and Gynecology International |
| Online Access: | http://dx.doi.org/10.1155/2017/9543570 |
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| author | Shinji Tanigaki Chie Nagata Kazunori Ueno Nobuaki Ozawa Shinichi Nagaoka Kei Tanaka Haruhiko Sago Mitsutoshi Iwashita |
| author_facet | Shinji Tanigaki Chie Nagata Kazunori Ueno Nobuaki Ozawa Shinichi Nagaoka Kei Tanaka Haruhiko Sago Mitsutoshi Iwashita |
| author_sort | Shinji Tanigaki |
| collection | DOAJ |
| description | Background. Caesarean scar pregnancy (CSP) is a rare ectopic pregnancy associated with life-threatening complications. To date, no therapeutic protocols have been established. Sono-guided local methotrexate (MTX) injection is a relatively easy and low-invasive treatment. Additional systemic MTX is sometimes needed for CSP cases, especially when β-subunit human chorionic gonadotropin (β-hCG) levels are >20,000 mIU/ml at diagnosis. We report on six cases of CSP treated with local MTX injection, five of which received combined local treatment. Methods. Under intravenous anesthesia, six CSPs including a case with β-hCG levels >20,000 mIU/ml received MTX injection to the gestational sac. Five cases received gestational sac aspiration. Three cases had additional local potassium chloride injection and one case had a saline injection aiming at the fetal heart beat concurrent with MTX injection. MTX was administered weekly if β-hCG levels stayed beyond the expected values. Outcomes. All cases achieved β-hCG normalization without additional systemic MTX, with one case having a successful pregnancy after treatment. Conclusion. Sono-guided local MTX injection with concurrent local treatment might be a potentially effective approach for CSP cases. The accumulation of further cases is necessary to confirm this. |
| format | Article |
| id | doaj-art-f6656235c0e74e40ad0e10efcce8a276 |
| institution | Kabale University |
| issn | 1687-9589 1687-9597 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Obstetrics and Gynecology International |
| spelling | doaj-art-f6656235c0e74e40ad0e10efcce8a2762025-02-03T01:02:08ZengWileyObstetrics and Gynecology International1687-95891687-95972017-01-01201710.1155/2017/95435709543570Successful Treatment of Caesarean Scar Pregnancies by Local Treatment OnlyShinji Tanigaki0Chie Nagata1Kazunori Ueno2Nobuaki Ozawa3Shinichi Nagaoka4Kei Tanaka5Haruhiko Sago6Mitsutoshi Iwashita7Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, JapanDepartment of Education for Clinical Research, National Center for Child Health and Development, Tokyo, JapanDepartment of Obstetrics and Gynecology, Kawasaki Municipal Hospital, Kawasaki, JapanCenter for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, JapanDepartment of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, JapanDepartment of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, JapanCenter for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, JapanDepartment of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, JapanBackground. Caesarean scar pregnancy (CSP) is a rare ectopic pregnancy associated with life-threatening complications. To date, no therapeutic protocols have been established. Sono-guided local methotrexate (MTX) injection is a relatively easy and low-invasive treatment. Additional systemic MTX is sometimes needed for CSP cases, especially when β-subunit human chorionic gonadotropin (β-hCG) levels are >20,000 mIU/ml at diagnosis. We report on six cases of CSP treated with local MTX injection, five of which received combined local treatment. Methods. Under intravenous anesthesia, six CSPs including a case with β-hCG levels >20,000 mIU/ml received MTX injection to the gestational sac. Five cases received gestational sac aspiration. Three cases had additional local potassium chloride injection and one case had a saline injection aiming at the fetal heart beat concurrent with MTX injection. MTX was administered weekly if β-hCG levels stayed beyond the expected values. Outcomes. All cases achieved β-hCG normalization without additional systemic MTX, with one case having a successful pregnancy after treatment. Conclusion. Sono-guided local MTX injection with concurrent local treatment might be a potentially effective approach for CSP cases. The accumulation of further cases is necessary to confirm this.http://dx.doi.org/10.1155/2017/9543570 |
| spellingShingle | Shinji Tanigaki Chie Nagata Kazunori Ueno Nobuaki Ozawa Shinichi Nagaoka Kei Tanaka Haruhiko Sago Mitsutoshi Iwashita Successful Treatment of Caesarean Scar Pregnancies by Local Treatment Only Obstetrics and Gynecology International |
| title | Successful Treatment of Caesarean Scar Pregnancies by Local Treatment Only |
| title_full | Successful Treatment of Caesarean Scar Pregnancies by Local Treatment Only |
| title_fullStr | Successful Treatment of Caesarean Scar Pregnancies by Local Treatment Only |
| title_full_unstemmed | Successful Treatment of Caesarean Scar Pregnancies by Local Treatment Only |
| title_short | Successful Treatment of Caesarean Scar Pregnancies by Local Treatment Only |
| title_sort | successful treatment of caesarean scar pregnancies by local treatment only |
| url | http://dx.doi.org/10.1155/2017/9543570 |
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