title: Diagnosis and management of cesarean scar pregnancy.
abstract: OBJECTIVE
  To evaluate the diagnosis and management modalities of cesarean scar pregnancy according to our experience.
  
  
  METHODS
  Retrospective study at the Women's Health Research and Education Hospital.
  
  
  METHODS
  Six patients were diagnosed and treated for cesarean scar pregnancy (CSP) with dilatation and curettage, methotrexate (MTX), or laparatomy.
  
  
  RESULTS
  One patient chose the surgical option due to her desire to have a tubal ligation. In the second case methotrexate was applied initially, but two weeks later suction curretage was applied due to abdominal pain and vaginal bleeding. Suction curettage was used as an initial treatment for four patients. There were not any complications in three of four patients. One patient had heavy vaginal bleeding which started after curettage. On ultrasonographic examination, increasing hemorrhage was seen between the uterus and the bladder so subtotal hysterectomy was performed.
  
  
  CONCLUSIONS
  Ultrasound should be used effectivelly in evaluation of pregnant patients with previous cesarean deliveries. There is still no unique treatment modality for CSP, so treatment should be tailored for each patient. Before the 7th week, abortion should be considered. After the 7th week, MTX and/or surgical options should be preferred.
authors.affiliation: Department of Obstetrics and Gynecology, Istanbul Bakirkoy Women and Children Hospital, Istanbul, Turkey. dripolat@yahoo.com
authors.forename: I
authors.initials: I
authors.lastname: Polat
authors.forename: I
authors.initials: I
authors.lastname: Alkis
authors.forename: A
authors.initials: A
authors.lastname: Sahbaz
authors.forename: O
authors.initials: O
authors.lastname: Sahin
authors.forename: A
authors.initials: A
authors.lastname: Ekiz
authors.forename: B
authors.initials: B
authors.lastname: Gulac
authors.forename: A I
authors.initials: AI
authors.lastname: Tekirdag
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use; D000328:Adult; D002585:Cesarean Section; D002921:Cicatrix; D004107:Dilatation and Curettage; D005260:Female; D005865:Gestational Age; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging* / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D014463:Ultrasonography
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate