الفهرس 
CESAREAN SECTIONOnly 14 pages are availabe for public view
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Abstract
Cesarean scar pregnancy (CSP) is a rare form of ectopic, pregnancy resulting from implantation of an embryo on previous cesarean scar. It can be devastating because of complications such as uterine rupture and massive hemorrhage, leading to increased maternal morbidity and mortality.
Up to 72% of cesarean scar pregnancies occur in women who have had 2 or more cesarean deliveries. The dehiscent myometrial defect may be related to incomplete healing or increased fibrosis along the uterine scar. Fibrosis occurring after multiple cesarean deliveries leads to poor vascularity, which impairs healing.
Methotrexate is an antimetabolite drug that has been used successfully in conditions associated with trophoblastic proliferation. Systemic methotrexate is a standard treatment for tubal and cervical ectopic pregnancy in early gestational age.
Systemic or local methotrexate therapy could avoid unnecessary laparotomy and preserve fertility in some patients, but it required time and patience.
As cesarean scar pregnancy is a condition of reproductive age, the conservation of fertility is the main concern for the patient and the gynecologist. Therefore, invasive and radical treatments, such as hysterectomy and hystorotomy, have recently been replaced by medical and minimally invasive therapies, and also some combinations of both.
The aim of this study is to evaluate the efficacy and safety of methotrexate therapy for the treatment of cesarean scar pregnancy according to last five years’ experience of Ain Shams University maternity hospital.
In this study, patients diagnosed as cesarean scar ectopic pregnancy between 4-9 weeks from LMP received medical treatment consisted of 1 mg/kg methotrexate, 75 mg total, intramuscular, day 1 was the day that MTX was administered and basal hCG was measured, on Day 7, a serum hCG concentration was drawn. There was a decrease in hCG less than 15 percent, so a second dose of MTX 50 mg/m2 IM was given. An additional 3rd dose of MTX was given and no repeating of pretreatment laboratory testing (complete blood count, renal and liver function tests) was required.
In the current study, there was no significant difference between the percent of decreasing BHCG level at end of follow up with the cardiac activity (p > 0.05).
There was also no significant statistical difference between the percent of decreasing BHCG level at end of follow up with the presence of vascularity (p > 0.05).
In addition, there was no significant statistical difference between the Percent of decreasing BHCG level (mIU/ml) and maternal and gestational age, sac diameter and myometrial layer thickness (p > 0.05).
On the other hand, the level of BHCG at baseline was 7705.7±1466.1, and decreased insignificantly at time 1 to be 7019.8±1439.7, at second time the level of BHCG decreased significantly to be 4496.5±1800.4, finally at end of follow up the level of BHCG significantly decreased to be 2964.4±897.3.
It was found that there was a positive significant correlation between BHCG level (mIU/ml) at end of follow up and BHCG level at base line after methotrexate injection (P> 0.05).
Our study demonstrated that the use of systemic methotrexate therapy results in significant reduction of the level of BHCG level in the eleven diagnosed patients of cesarean scar ectopic pregnancy within the last five years at Ain Shams maternity hospital (P> 0.05).