A retrospective review of uterine scar pregnancies: single centre experience.
OBJECTIVE
Our aim was to present our experience with the management of six women with uterine scar pregnancies in KK Women's and Children's Hospital, Singapore.


METHODS
The medical records of women with a pregnancy in previous uterine scar that had been diagnosed in our department during 2004-2008 were reviewed.


RESULTS
Out of six women, one woman presented in mid-trimester, at 16 weeks with severe abdominal pain and persistent vomiting. She underwent a hysterectomy complicated with massive haemorrhage. The other five women presented in first trimester. Two women had excision of the scar with the sac, two had ultrasound-guided injection of methotrexate in the sac and one had systemic methotrexate. In all cases, maternal recovery was complete. Uterine scar pregnancy was diagnosed by ultrasonography.


CONCLUSIONS
Women at a risk appear to be those with multiple Caesarean sections, termination of pregnancy and myomectomy. Operative as well as medical treatments have been reported for scar pregnancy. Surgical treatment includes excision of trophoblastic tissues by laparotomy or laparoscopy whilst medical treatment includes local and/or systemically administered methotrexate. Although many interventions have been described, optimal treatment is still not known and they remain a challenge.
Maternal Fetal Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore. shephul@yahoo.com
Shephali
S
Tagore
S H Wendy
SH
Teo
S Y Irene
SY
Chua
Chiou Li
CL
Ong
Y C Kenneth
YC
Kwek
D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D012189:Retrospective Studies
D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate