title: Abruptio placentae in subsequent pregnancy after conservative management of hemorrhagic cesarean scar pregnancy by transcatheter arterial chemoembolization.
abstract: BACKGROUND
  Cesarean scar pregnancy is a rare but dangerous type of ectopic pregnancy in which implantation occurs within the fibrous tissue of a cesarean scar defect. Conservative management of cesarean scar pregnancy is challenging, especially when future fertility preservation is a significant concern. Furthermore, reports on significant maternal morbidity in subsequent pregnancies after successful conservative management of cesarean scar pregnancy are limited.
  
  
  METHODS
  A 31-year-old woman with previous history of 2 cesarean sections transferred due to massive uterine hemorrhage 7 weeks after dilatation and curettage performed under the diagnosis of missed abortion at 7 weeks of gestation. Cesarean scar pregnancy was diagnosed and was conservatively managed by emergent transcatheter arterial chemoembolization (TACE) followed by multiple doses of systemic methotrexate administration. Seven months after TACE, she spontaneously conceived. At 36 weeks and 5 days of pregnancy, emergency cesarean section was performed due to sudden massive hemorrhage. Abruptio placentae was diagnosed when hysterotomy was performed. After manual removal of the placenta, a healthy infant was delivered. The postoperative course was uneventful.
  
  
  CONCLUSIONS
  The pregnancy course should be carefully monitored for early detection of maternal morbidity associated with placental abnormalities to achieve successful outcome in subsequent gestations after conservative management of cesarean scar pregnancy.
authors.affiliation: Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Takeda
authors.forename: Sanae
authors.initials: S
authors.lastname: Imoto
authors.forename: Hiromi
authors.initials: H
authors.lastname: Nakamura
keywords: abruptio placentae; cesarean scar pregnancy; methotrexate; transcatheter arterial chemoembolization