title: [Diagnosis, treatment, and follow-up of cesarean scar pregnancy].
abstract: OBJECTIVE
  Cesarean scar pregnancy is a rare entity. This situation may induce uterine rupture and/or a massive life-threatening hemorrhage. The standard treatment is laparotomy surgery, but in situ injections to replace invasive surgery. The objective of this study was to focus on the diagnosis, optimal management and long-term follow-up of the patients.
  
  
  METHODS
  Data from 6 patients with diagnosis of cesarean scar pregnancy between 2007 and 2013 at Lariboisière hospital were retrospectively collected.
  
  
  RESULTS
  Endovaginal ultrasound succeeded to diagnose all cases. Four patients were treated with in situ injection of methotrexate performing a vaginal way (n=2) or laparoscopy (n=2) and two others using systemic injection. One patient was complicated by hemorrhagic shock requiring iterative embolizations. Three patients achieved a new pregnancy, with one recurrent scar pregnancy complicated by massive hemorrhage.
  
  
  CONCLUSIONS
  Diagnosis and treatment of cesarean scar pregnancies must be done precociously because of high hemorrhage risks. Endovaginal ultrasound is the gold standard exam. Treatment is non-consensual, but methotrexate in situ injection is effective and safer. Monitoring the decrease of HCG levels and ultrasonography supervision of gestational sac size and its vascularization must be performed. Due to the risk of recurrence, any subsequent pregnancy shows a high risk of complications.
authors.affiliation: Service de gynécologie-obstétrique, hôpital Lariboisière, université Paris Diderot, Sorbonne Paris-Cité, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France.
authors.forename: H-T
authors.initials: HT
authors.lastname: Nguyen-Xuan
authors.affiliation: Service de gynécologie-obstétrique, hôpital Lariboisière, université Paris Diderot, Sorbonne Paris-Cité, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Service de gynécologie-obstétrique, hôpital intercommunal de Créteil, université Paris Est, Paris XII, 40, avenue de Verdun, 94000 Créteil, France. Electronic address: rubenlousquy@gmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Lousquy
authors.affiliation: Service de gynécologie-obstétrique, hôpital Lariboisière, université Paris Diderot, Sorbonne Paris-Cité, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Centre Antoine-Lacassagne, pôle de chirurgie oncologique générale, gynécologique et mammaire, 33, avenue de Valombrose, 06189 Nice cedex 2, France.
authors.forename: E
authors.initials: E
authors.lastname: Barranger
mesh_terms: D002585:Cesarean Section; D002921:Cicatrix; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008727:Methotrexate / Q000008:administration & dosage; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis* / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D014592:Uterine Hemorrhage; D014597:Uterine Rupture
chemical_list: D008727:Methotrexate
keywords: Cesarean scar pregnancy; Ectopic pregnancy; Embolisation; Embolization; Grossesse ectopique; Grossesse intracicatricielle; Methotrexate; Méthotrexate; Pathologie placentaire; Placental pathology