Different Treatment Modalities for Cesarean Scar Pregnancies in Sulaimani Maternity Teaching Hospital

Shadia Ahmed  Faydhulla; Srwa Jamal  Murad; Chro Najmadeen  Fattah

doi:10.56056/amj.2025.345

Authors

Shadia Ahmed Faydhulla MBChB, KHCMS/Obstetrics and Gynecology Trainee, Sulaimani Maternity Teaching Hospital, Sulaimani Directorate of Health, Sulaimaniyah, Iraq
Srwa Jamal Murad MBChB, KSGE, KEL, FIBMS, OBGYN, MRCOG, Assistant Professor of Obstetrics and Gynecology at Department of Clinical Sciences, College of Medicine, University of Sulaimani, Sulaimaniyah, Iraq
Chro Najmadeen Fattah MBChB, DGO, MRCPI, FRCOG, MD, Professor of Obstetrics and Gynecology at Department of Clinical Sciences, College of Medicine, University of Sulaimani, Sulaimaniyah, Iraq

DOI:

https://doi.org/10.56056/amj.2025.345

Keywords:

Cesarean scar, Cross-sectional study, Ectopic pregnancy, Treatment modality

Abstract

Background and objectives: Cesarean scar ectopic pregnancy is one of the most severe complications of cesarean delivery. Thus, we aimed to evaluate the cesarean scar ectopic pregnancy and treatment modalities.

Methods: A cross-sectional study was conducted on 30 cesarean scar ectopic pregnant women who attended the Sulaimani Maternity Teaching Hospital, from May 2022 to May 2023. The cesarean scar ectopic pregnancy among studied women was diagnosed with ultrasound, and then a validated questionnaire was used to collect their sociodemographic and clinical data. Blood samples were collected to estimate the Beta-Human Chorionic Gonadotrophin hormone level.

Results: Most women (83.3%) were aged 20-40 years, overweight (46.7%), had bleeding (56.7%), endogenous scar (83.3%), and two caesarean section histories (33%). Moreover, most women (60%) had surgical treatment, and had a Beta-Human Chorionic Gonadotrophin level of >10,000 mIU/mL. The fetal heart rate was negative in most women (77.78%) who needed surgical treatments, while it was positive in 58.33% of women who required systemic methotrexate with suction curettage (p=0.044). Furthermore, most patients in both groups (83.33%) had endogenous scars (p=1.0). Bleeding was the most prevalent complaint in both groups (p=0.369). Suction curettage was the most practiced modality in a group of surgical therapy (55.56%), while systemic methotrexate with suction curettage was the most practiced in another treatment modality group (58.33%).

Conclusions: Surgery alone or combination therapy are effective and safe treatment methods for cesarean scar ectopic pregnancy that were not affected by maternal sociodemographic and clinical features.

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References

Timor-Tritsch IE, Monteagudo A, Calì G, D’Antonio F, Agten AK. Cesarean scar pregnancy: patient counseling and management. Obstet Gynecol Clin. 2019; 46(4):813-828.

Saxena R. Textbook for MRCOG-1: Basic Sciences in Obstetrics & Gynaecology. Jaypee Brothers Medical Publishers; 2019.

Grechukhina O, Deshmukh U, Fan L, Kohari K, Abdel-Razeq S, Bahtiyar MO, et al. Cesarean scar pregnancy, incidence, and recurrence: five-year experience at a single tertiary care referral center. Obstet Gynecol. 2018; 132(5):1285-1295.

Al-Jaroudi D, Aboudi S, Baradwan S. Different treatment modalities for cesarean scar pregnancies: a single-center experience and literature review. Arch Gynecol Obstet. 2021; 303:1143-1151.

Hoffman BL, Schorge JO, Bradshaw KD, Halvorson LM, Schaffer JI, Corton MM. Williams Gynecology. New York: McGraw-Hill Education; 2016.

Glenn TL, Bembry J, Findley AD, Yaklic JL, Bhagavath B, Gagneux P, et al. Cesarean scar ectopic pregnancy: current management strategies. Obstet Gynecol Surv. 2018; 73(5):293-302.

Noël L, Thilaganathan B. Caesarean scar pregnancy: diagnosis, natural history and treatment. Curr Opin Obstet Gynecol. 2022; 34(5):279-286.

Litwicka K, Greco E. Caesarean scar pregnancy: a review of management options. Curr Opin Obstet Gynecol. 2013; 25(6):456-461.

Kanat-Pektas M, Bodur S, Dundar O, Bakir VL. Systematic review: what is the best first-line approach for cesarean section ectopic pregnancy Taiwan J Obstet Gynecol. 2016; 55(2):263-269.

Lee JH, Kwon DH, Ahn KH, Hong SC, Kim T. Concomitant ultrasound-guided intra-gestational sac methotrexate-potassium chloride and systemic methotrexate injection in the recurrent cesarean scar pregnancy. Obstet Gynecol Sci. 2016; 59(3):245-248.

Ben Nagi J, Helmy S, Ofili-Yebovi D, Yazbek J, Sawyer E, Jurkovic D. Reproductive outcomes of women with a previous history of Caesarean scar ectopic pregnancies. Hum Reprod. 2007; 22(7):2012-2015.

Riaz RM, Williams TR, Craig BM, Myers DT. Cesarean scar ectopic pregnancy: imaging features, current treatment options, and clinical outcomes. Abdom Imaging. 2015; 40:2589-2599.

Yamaguchi M, Ohba T, Katabuchi H. Safety and efficacy of a single local methotrexate injection for cesarean scar pregnancy. J Minim Invasive Gynecol. 2022; 29(3):416-423.

Gerday A, Lourtie A, Pirard C, Laurent P, Wyns C, Jadoul P, et al. Experience with medical treatment of cesarean scar ectopic pregnancy (CSEP) with local ultrasound-guided injection of methotrexate. Front Med. 2020; 7:564764.

Gao L, Huang Z, Zhang X, Zhou N, Huang X, Wang X. Reproductive outcomes following cesarean scar pregnancy–a case series and review of the literature. Eur J Obstet Gynecol Reprod Biol. 2016; 200:102-107.

Kutuk MS, Uysal G, Dolanbay M, Ozgun MT. Successful medical treatment of cesarean scar ectopic pregnancies with systemic multidose methotrexate: Single center experience. J Obstet Gynaecol Res. 2014; 40(6):1700-1706.

Roche C, McDonnell R, Tucker P, Jones K, Milward K, McElhinney B, et al. Caesarean scar ectopic pregnancy: evolution from medical to surgical management. Aust N Z J Obstet Gynaecol. 2020; 60(6):852-857.

Jurkovic D, Knez J, Appiah A, Farahani L, Mavrelos D, Ross J. Surgical treatment of Cesarean scar ectopic pregnancy: efficacy and safety of ultrasound guided suction curettage. Ultrasound Obstet Gynecol. 2016; 47(4):511-517.

Godin P-A, Bassil S, Donnez J. An ectopic pregnancy developing in a previous caesarian section scar. Fertil Steril. 1997; 67(2):398-400.

Weerakkody Y, Yap J, El-Feky M. Cesarean scar ectopic pregnancy. Radiopaedia. 2022.

Huanxiao Z, Shuqin C, Hongye J, Hongzhe X, Gang N, Chengkang X, et al. Transvaginal hysterotomy for cesarean scar pregnancy in 40 consecutive cases. Gynecol Surg. 2015; 12:45-51.

Wang G, Liu X, Bi F, Yin L, Sa R, Wang D, et al. Evaluation of the efficacy of laparoscopic resection for the management of exogenous cesarean scar pregnancy. Fertil Steril. 2014; 101(5):1501-1507.