Evaluation of management of Cesarean Scar Pregnancy (CSP).

Abstract

Objective: To evaluate our experience in treatment of Caesarean Scar Pregnancy (CSP). Study Design: Cross Sectional Descriptive study. Setting: Department of Gynecology and Obstetrics, Independent Medical College Faisalabad. Period: Jan 2016 to Jan 2021. Material & Methods: The data for this study retrospectively obtained from outpatient department, emergency ward and labor ward registers. Data was analyzed by simple descriptive statics. Diagnosis of CSP was made by using transvaginal ultrasound and color flow Doppler ultrasound. Treatment offered was either medical management as systemic methotrexate or surgical as D&C or laparotomy. The aim was to do conservative treatment for fertility sparing. Patient age, gestational age at time of presentation, number of previous Cesarean Section and success of overall management strategy was analyzed. Results: In this study we had 12 patients diagnosed to have CSP with at least one scar on uterus of previous caesarean section. The mean age of patients was 32.5± 2 years and the gestational age range was from 5 weeks and 3 days to 10 weeks and 1 day. The diagnosis was done by using transvaginal ultrasound and color flow Doppler ultrasound. Which showed high velocity and low impedance flow in sub trophoblastic area. Out of 12 patient’s 58.33 percent were treated with systemic methotrexate and had successful outcome. These were followed by B-hCG levels till non pregnant serum level of B-hCG of <5.1IU was achieved. 16.66 percent patients underwent D&C, but due to hemorrhage they were treated with laparotomy as supplementary procedure. 41.55 percent Patients were treated by laparotomy as their primary management with aim of fertility sparing surgery. The laparotomy was found to be successful treatment in all the patients who underwent surgical management as their primary treatment. Conclusion: Prompt diagnosis has pivotal role in reducing morbidity and mortality associated with CSP. Medical management is found to be successful at early gestational age. Fertility sparing surgery is better option as gestation advances more than 8 weeks to avoid undesirable outcome like hemorrhage and hysterectomy.