Elito Júnior Julio, Araujo Júnior Edward, Martins Santana Eduardo Félix, Szejnfeld Denis, Helfer Talita Micheletti, Nardozza Luciano Marcondes Machado, Moron Antonio Fernandes
Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo-SP, Brazil.
Med Ultrason. 2013 Sep;15(3):240-3. doi: 10.11152/mu.2013.2066.153.jej1eaj2.
Cesarean scar pregnancy is a rare form of ectopic pregnancy. It is associated with many complications, including a high risk of massive bleeding and hysterectomy under unfavorable conditions. Conservative treatment with systemic methotrexate (MTX) has been used preferentially with the aim of allowing the patient to have a reproductive future. However, cases of complex ectopic masses in a cesarean scar with guarded prognosis demand techniques that are more effective, such as uterine artery embolization (UAE) in association with intra-arterial MTX infusion. We describe the case of a 35-year-old patient in the 8th week of pregnancy who was referred to us because of genital bleeding and suspected ectopic pregnancy in the cesarean scar. After confirmation of the diagnosis, an initial attempt at systemic treatment with MTX was made. This was abandoned due to the elevation of the hepatic transaminase level. In addition, because of the complexity of the mass and the patient's desire to preserve her reproductive capacity, it was decided to perform UAE with local MTX infusion. The procedure was performed successfully and the patient's fertility was preserved.
剖宫产瘢痕妊娠是一种罕见的异位妊娠形式。它与许多并发症相关，包括在不利情况下发生大出血和子宫切除的高风险。以让患者拥有生育未来为目的，优先使用甲氨蝶呤（MTX）全身保守治疗。然而，剖宫产瘢痕处复杂异位包块且预后不佳的病例需要更有效的技术，如子宫动脉栓塞术（UAE）联合动脉内MTX灌注。我们描述了一名35岁妊娠8周的患者，因阴道出血和疑似剖宫产瘢痕处异位妊娠前来就诊。确诊后，首先尝试用MTX进行全身治疗。因肝转氨酶水平升高而放弃。此外，由于包块复杂且患者希望保留生育能力，决定行UAE并局部灌注MTX。手术成功进行，患者的生育能力得以保留。
