Masten Megan, Alston Meredith
Obstetrics and Gynecology, Denver Health and Hospitals, Denver, USA.
Obstetrics and Gynecology, Saint Joseph Hospital, Denver, USA.
Cureus. 2023 Mar 15;15(3):e36200. doi: 10.7759/cureus.36200. eCollection 2023 Mar.
Cesarean scar pregnancy (CSP), or pregnancies with implantation in a prior cesarean section scar, are rare but may be becoming more common with an increase in cesarean section deliveries. History of prior CSP may also increase the risk for recurrent CSP. Several treatment options and combinations of treatment options for CSP have been described in the literature. Although the optimal treatment is unclear, the Society of Maternal-Fetal Medicine published recommendation guidelines, which include recommendations for the treatment/termination of CSP pregnancies. Treatment of CSP is recommended with operative resection, ultrasound-guided suction dilation and curettage (D&C), or intragestational methotrexate with or without treatment modalities. This is a case report of a patient with recurrent CSP. Her first CSP was incorrectly diagnosed as an incomplete abortion after unsuccessful treatment with misoprostol alone and ultimately was successfully treated with systemic methotrexate. Her second CSP is the basis of this case report and was successfully treated with oral mifepristone and systemic methotrexate (50 milligrams/meter) before an ultrasound-guided suction D&C at 10 weeks 1 day gestational age. The combination of mifepristone, systemic methotrexate, and suction D&C under ultrasound guidance as a treatment for recurrent CSP has not previously been described in published literature.
剖宫产瘢痕妊娠（CSP），即妊娠囊着床于既往剖宫产瘢痕处，较为罕见，但随着剖宫产分娩数量的增加，其发生率可能正逐渐上升。既往有CSP病史也可能增加复发性CSP的风险。文献中已描述了几种CSP的治疗方案及治疗方案组合。尽管最佳治疗方法尚不清楚，但母胎医学协会发布了推荐指南，其中包括CSP妊娠治疗/终止的建议。推荐采用手术切除、超声引导下吸刮术（D&C）或妊娠内甲氨蝶呤联合或不联合其他治疗方式来治疗CSP。本文报告了一例复发性CSP患者。她的首次CSP在仅使用米索前列醇治疗失败后被误诊为不全流产，最终通过全身应用甲氨蝶呤成功治疗。她的第二次CSP是本病例报告的基础，在孕10周0天进行超声引导下吸刮术之前，先采用口服米非司酮和全身应用甲氨蝶呤（50毫克/米²）成功治疗。米非司酮、全身应用甲氨蝶呤及超声引导下吸刮术联合用于治疗复发性CSP此前在已发表的文献中尚未见报道。
