Sendy Feras, Ahmeed Samer J, Obaid Sulaiman Al, Sallout Bahaaldden, Sendy Sameer
Department of Obstetrics and Gynecology, CHU Estaing, Clermont-Ferrand, France.
Faculty of Medicine, Université Clermont Auvergne, Clermont-Ferrand, France.
Ochsner J. 2020 Winter;20(4):463-466. doi: 10.31486/toj.20.0121.
Cesarean scar pregnancy is a rare, potentially life-threatening complication in patients with prior cesarean delivery. Vaginal bleeding is a common presenting symptom. A 23-year-old female who presented with mild vaginal bleeding was diagnosed by transvaginal ultrasound with a viable cesarean scar pregnancy of 7 weeks' gestation. After the sac content was suctioned through a transvaginal approach under ultrasound guidance, the patient was injected with 50 mg local and 25 mg systemic methotrexate. One week later, a repeat systemic methotrexate dose of 50 mg was administered. The patient's beta human chorionic gonadotropin (hCG) levels were followed weekly until a negative beta hCG level was established. No management approach has been universally approved for cesarean scar pregnancy; the best option depends on case presentation, surgeon experience, and available facilities. We suggest that our minimally invasive treatment is an acceptable approach, especially if embryonic cardiac activity is present. We recommend the referral of such cases to tertiary centers to avoid complications.
剖宫产瘢痕妊娠是既往有剖宫产史患者中一种罕见的、可能危及生命的并发症。阴道出血是常见的临床表现。一名23岁女性因轻度阴道出血就诊，经阴道超声诊断为妊娠7周的存活剖宫产瘢痕妊娠。在超声引导下经阴道途径吸出囊内容物后，给患者注射了50mg局部甲氨蝶呤和25mg全身甲氨蝶呤。一周后，再次给予50mg全身甲氨蝶呤。每周监测患者的β-人绒毛膜促性腺激素（hCG）水平，直至β-hCG水平转为阴性。目前尚无针对剖宫产瘢痕妊娠的普遍认可的治疗方法；最佳选择取决于病例情况、外科医生经验和可用设备。我们认为我们的微创治疗是一种可接受的方法，尤其是在存在胚胎心搏的情况下。我们建议将此类病例转诊至三级中心以避免并发症。
