Diagnosis and Treatment of Cesarean Scar Pregnancies
This study by Timor-Tritsch et al. (AJOG, 2012) examined the diagnostic method, treatments, and long-term follow up of cesarean scar pregnancy (CSP).
Retrospective Case Study
26 patients between 6-14 postmenstrual weeks who had confirmed CSP with transvaginal ultrasound were followed. 19 of the patients had the following protocol: (1) 50 mg methotrexate was injected into the gestational sac, equally divided around the fetus and the placental area; (2) an additional 25 mg of methotrexate was administered intramuscularly. Serial serum human chorionic gonadotropin determinations were obtained. 3D ultrasound was used to assess gestational sac volumes and vascularization as well as to monitor resolution of the injected site and outcome.
The treated pregnancies were followed for 24-177 days and there were no complications observed. This study found that the protocol of combined intramuscular and intragestational methotrexate injection were effective in treating CSP.
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