Tsakiridis Ioannis, Chatzikalogiannis Ioannis, Mamopoulos Apostolos, Dagklis Themistoklis, Tsakmakidis Georgios, Athanasiadis Apostolos, Kalogiannidis Ioannis
Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece.
Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece.
Int J Surg Case Rep. 2019;65:238-241. doi: 10.1016/j.ijscr.2019.11.002. Epub 2019 Nov 6.
The incidence of cesarean scar pregnancies (CSPs) is increasing, possibly due to higher rates of cesarean sections. We report a case of a CSP with severe bleeding following initial conservative management, that was eventually treated surgically.
A 33-year old woman with history of one cesarean section presented with abdominal pain and amenorrhea and was diagnosed with CSP. Conservative management with methotrexate was chosen and the treatment was regarded as successful after the expected reduction in serum hCG levels. Four days after the hospital discharge, the patient was readmitted with hemodynamic instability and an emergency laparotomy was performed to remove the remaining trophoblastic tissue.
A CSP may present as a threatened miscarriage, or remain asymptomatic through the first trimester. Medical treatment may be successful, however a close follow-up is needed even after a reduction in serum hCG levels.
We report a case of CSP that, following an initial apparently "successful" treatment with methotrexate, required surgical management due to heavy bleeding.
剖宫产瘢痕妊娠（CSP）的发生率正在上升，可能是由于剖宫产率较高。我们报告一例CSP患者，在初始保守治疗后出现严重出血，最终接受了手术治疗。
一名有剖宫产史的33岁女性因腹痛和闭经就诊，被诊断为CSP。选择甲氨蝶呤进行保守治疗，血清人绒毛膜促性腺激素（hCG）水平预期下降后，治疗被视为成功。出院4天后，患者因血流动力学不稳定再次入院，接受了急诊剖腹手术以清除剩余的滋养层组织。
CSP可能表现为难免流产，或在孕早期无症状。药物治疗可能成功，但即使血清hCG水平下降后仍需密切随访。
我们报告一例CSP病例，在最初使用甲氨蝶呤进行的看似“成功”的治疗后，因大出血需要手术治疗。
