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Jan 2020, Vol 8, Issue 1
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Original Article
The Success of Surgical and Medical Approach in the Treatment of Cesarean Scar Pregnancy
Sara Masihi, Mahin Najafian, Mojgan Barati, Zohreh Mirfazli
Faculty of Medicine, Fertility, Infertility and Perinatology Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran


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Keywords : Cesarean scar pregnancy, Hysteroscopy, B-hCG resolution, Ectopic pregnancy
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Abstract

Objectives : One of the potentially dangerous and late complications of Cesarean section is the ectopic pregnancy in the CS scar(CSP). In the current study we have aimed to evaluate the therapeutic approaches in managing CS scar ectopic pregnancy

Materials and Methods: This cross-sectional study was carried out on 63  CSP patients. Treatment approach was considered based on the shape and nature of the Gestational sac during ultrasound evolution's. Patients' demographic data, clinical manifestations, systemic drug treatment (methotrexate), type of surgery, hospitalization times, and treatment related complications were evaluated.The treatment efficacy in different approaches was compared based on the hCG resolution time.

Results: The mean age of the subjects was 34.2±5.1 years (in range of 22 to 44 years). Median of B-hCG serum levels at diagnosis was 2319 IU. The most common complaint was vaginal bleeding and abdominal pain (27(42.9%)), followed by Delayed menstrual cycle(8(12.7%)). The majority of patients subjected to surgical treatment and 29 cases(46%) were treated by medical approaches The median time to B-hCG resolution was 42 days. The Cox proportional hazards model showed the significant effect of treatment approach on time to B-hCG resolution(X2=37.78, df=4,p<0.0001). The MTX plus surgery was the most effective treatment approach(OR=10.56, p<0.0001) in managing CSP patients.

Conclusion: Our findings in line with previous studies showed the superiority of surgical approach alone or combination with medical treatments than medical approaches alone.

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