Learning Experience with Management of Caesarean-Scar Pregnancy

Background: With a rise in incidence of cesarean sections, repeat cesarean deliveries, and improvement in diagnostic modalities an increasing number of caesarean-scar pregnancies (CSPs) have been diagnosed and reported. Although a panoramic transabdominal view of the pelvis with Doppler imaging provides a high diagnostic accuracy, the literature still reports misdiagnoses in 36% of such cases, leading to diagnostic confusion. This might be due to similarity in the presentation of CSPs with incomplete abortions leading to reflexive check curettage in patients that fully distorts the findings on later ultrasounds. Cases: The current authors report on their experience, within a short span of 23 months, with 3 patients who had CSPs. The first patient was diagnosed after laparotomy only, the second patient underwent an emergency hysterectomy as a life-saving procedure, and the third patient responded to a single-dose methotrexate injection. Results: Two of the 3 patients had their CSPs removed surgically and had smooth recoveries. The methotrexate given to the third patient lowered her beta-human chorionic gonadotropin level to 48 mIU/ml and ultimately caused her to expel a mass resembling decidual tissue, which was confirmed by histopathologic examination. She remained stable throughout the treatment and responded well to it. Conclusions: A high index of suspicion by radiologists and obstetricians can play a pivotal role in the early diagnosis and treatment of CSP. Moreover, a careful selection of treatment modality is an art of learning that can be gained with experience. (J GYNECOL SURG 20XX:000)