Gulino Ferdinando Antonio, Pappalardo Elisa, Ettore Carla, Laganà Antonio Simone, Capriglione Stella, Ettore Giuseppe
Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy.
Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy.
Prz Menopauzalny. 2020 Jul;19(2):61-65. doi: 10.5114/pm.2020.97836. Epub 2020 Jul 13.
A caesarean scar pregnancy is a complex iatrogenic pathology, which represents a consequence of a previous caesarean section. It increased in recent years due to parallel increase of cesarean sections.
We present a retrospective study on patients with caesarean scar pregnancy diagnosed in our department from June 2016 to June 2019. Stable women with an embryo (with or without cardiac activity) who accepted our experimental protocol were treated with single dose of methotrexate (50 mg administered locally intracavitary + 50 mg administered intramuscularly) and folinic acid (15 mg/day orally for 30 days). Clinically stable women with embryo (without cardiac activity) who decided to wait, were monitored by serial assays of b-hCG and clinical and ultrasonographic follow up. Women who were clinically unstable with embryo (without cardiac activity), were referred for urgent surgical treatment with dilation and curettage.
Caesarean scar pregnancy was diagnosed in sixteen women. Among these women, seven were treated according to our experimental protocol with methotrexate and folinic acid and only one had profuse bleeding, which required a laparotomic hysterectomy. Four women were treated urgently with dilatation and curettage. Five women chose to wait: they were monitored and all spontaneously had a miscarriage.
In our preliminary study, we highlighted how our experimental protocol gave encouraging results in the first 10 weeks of caesarean scar pregnancy. However, caution is needed in patients with advanced gestational age, a gestational sac with large diameter, higher CRL and presence of embryonic cardiac activity.
剖宫产瘢痕妊娠是一种复杂的医源性病理状况，是既往剖宫产的后果。近年来，由于剖宫产率的并行上升，其发生率也有所增加。
我们对2016年6月至2019年6月在我科诊断为剖宫产瘢痕妊娠的患者进行了一项回顾性研究。接受我们实验方案的有胚胎（有或无心跳）的稳定女性接受单剂量甲氨蝶呤（局部宫腔内注射50mg + 肌肉注射50mg）和亚叶酸（口服15mg/天，共30天）治疗。决定等待的有胚胎（无心跳）的临床稳定女性，通过连续检测β-hCG以及临床和超声随访进行监测。有胚胎（无心跳）且临床不稳定的女性，被转诊进行紧急手术刮宫治疗。
16名女性被诊断为剖宫产瘢痕妊娠。在这些女性中，7名按照我们的实验方案接受了甲氨蝶呤和亚叶酸治疗，只有1名出现大出血，需要进行剖腹子宫切除术。4名女性接受了紧急刮宫治疗。5名女性选择等待：她们接受了监测，均自然流产。
在我们的初步研究中，我们强调了我们的实验方案在剖宫产瘢痕妊娠的前10周取得了令人鼓舞的结果。然而，对于孕周较大、孕囊直径较大、头臀长较高以及有胚胎心跳的患者，需要谨慎处理。
