title: Conservative management of two ectopic pregnancies implanted in previous uterine scars.
abstract: Cesarean section scar pregnancy is rare. A variety of interventions have been implemented to terminate the pregnancy and preserve the uterus; however, the optimal treatment is unknown. We describe two cases of this rare condition diagnosed by transvaginal ultrasound. In the first case the diagnosis of an 8-week non-viable gestation in a uterine scar was made sonographically in a 40-year-old woman. The patient was treated with intramuscular methotrexate. Myometrial integrity was suggested both by ultrasound findings and laparoscopic findings. In the second case, an early cervicoisthmic pregnancy in a uterine scar was diagnosed by sonography in a 39-year-old woman. This patient was treated successfully with a full course of intramuscular methotrexate. Complete disappearance of the gestational sac took place 4 months following beta-human chorionic gonadotrophin normalization. Intramuscular methotrexate may be a treatment alternative for Cesarean section scar pregnancies.
authors.affiliation: Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel. syagel@hadassah.org.il
authors.forename: R
authors.initials: R
authors.lastname: Haimov-Kochman
authors.forename: Y
authors.initials: Y
authors.lastname: Sciaky-Tamir
authors.forename: N
authors.initials: N
authors.lastname: Yanai
authors.forename: S
authors.initials: S
authors.lastname: Yagel
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal; D000328:Adult; D002585:Cesarean Section; D002921:Cicatrix; D005260:Female; D006801:Humans; D008727:Methotrexate; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging / Q000628:therapy*; D016216:Ultrasonography, Prenatal
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate