Jo Eun Ju, Cha Hyun-Hwa, Seong Won Joon
Department of Obstetrics and Gynecology, Kyungpook National University Hospital, School of Medicine, 807 Hogukro, Buk-gu, Daegu, 41404, Republic of Korea.
J Med Case Rep. 2019 Mar 7;13(1):53. doi: 10.1186/s13256-019-1983-1.
Cesarean scar pregnancy is rare but may be related to early uterine rupture and may result in massive hemorrhage. Nowadays, most cesarean scar pregnancies are diagnosed early and can be managed properly. However, diagnoses of cesarean scar pregnancies that develop in the obstetrical area are sometimes delayed.
A 28-year-old Asian woman visited our institution because of suspected cesarean scar pregnancy. Ultrasonography and computed tomography confirmed a cesarean scar pregnancy with a live fetus with a crown-rump length of 4.83 cm, corresponding to 11 weeks 6 days of gestation. Initially, we injected 50 mg of methotrexate in the amniotic sac under transabdominal ultrasonographic guidance. However, fetal cardiac activity was still observed 2 days later. We decided to perform open laparotomy because of the possibility of massive bleeding. The gestational sac was removed, as well as most of the trophoblastic tissues that were adherent and invading the wall of the lower uterine segment. She was discharged in good condition 5 days after the operation.
Despite the popular use of ultrasonography in prenatal care, diagnosis of cesarean scar pregnancy is still delayed. Surgical treatment with local methotrexate injection could be an option for the management of advanced cesarean scar pregnancy.
剖宫产瘢痕妊娠较为罕见，但可能与早期子宫破裂有关，并可能导致大出血。如今，大多数剖宫产瘢痕妊娠能被早期诊断并得到妥善处理。然而，发生在产科区域的剖宫产瘢痕妊娠有时会出现诊断延迟的情况。
一名28岁的亚洲女性因疑似剖宫产瘢痕妊娠前来我院就诊。超声检查和计算机断层扫描确诊为剖宫产瘢痕妊娠，胎儿存活，头臀长4.83厘米，相当于妊娠11周6天。最初，我们在经腹超声引导下向羊膜腔内注射了50毫克甲氨蝶呤。然而，两天后仍观察到胎儿心跳。由于存在大出血的可能性，我们决定进行开腹手术。取出了妊娠囊以及大部分附着并侵入子宫下段壁的滋养层组织。术后5天她康复出院。
尽管超声检查在产前保健中广泛应用，但剖宫产瘢痕妊娠的诊断仍会延迟。局部注射甲氨蝶呤的手术治疗可能是晚期剖宫产瘢痕妊娠管理的一种选择。
