title: Therapeutic options of caesarean scar pregnancy: case series and literature review.
abstract: We describe our experience with the treatment of 4 caesarean scar pregnancies and provide an overview of current literature. Four women diagnosed with a caesarean scar pregnancy in our hospital between 1996 and 2007 were treated with local or systemic methotrexate and had a steady decline of the serum beta-hCG level. The uterus was preserved in all women and 3 of them had an uneventful subsequent pregnancy and delivery. We suggest that transcervical needle aspiration of amniotic fluid followed by intra-amniotic injection of methotrexate should be the treatment of choice, followed by surgical treatment only if methotrexate fails.
authors.affiliation: Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: A J Marjolein Bij
authors.initials: AJ
authors.lastname: de Vaate
authors.forename: Hans A M
authors.initials: HA
authors.lastname: Brölmann
authors.forename: Johannes W
authors.initials: JW
authors.lastname: van der Slikke
authors.forename: Maurice G A J
authors.initials: MG
authors.lastname: Wouters
authors.forename: Roel
authors.initials: R
authors.lastname: Schats
authors.forename: Judith A F
authors.initials: JA
authors.lastname: Huirne
mesh_terms: D000328:Adult; D000650:Amnion; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000627:therapeutic use; D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix / Q000150:complications* / Q000000981:diagnostic imaging; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D007813:Laparotomy / Q000379:methods*; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use*; D009215:Myometrium; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*
chemical_list: D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate