Marie-Laure Legris1, Victor Gabriele2, Aline Host3, Chérif Akladios4, Olivier Garbin5, Lise Lecointre6. 1. Department of Gynecologic Surgery, Centre Médico-Chirurgical Obstétrique, 19 Rue Louis Pasteur, 67300 Schiltigheim, France. Electronic address: marie-laure.legris@chru-strasbourg.fr. 2. Department of Gynecologic Surgery, Centre Médico-Chirurgical Obstétrique, 19 Rue Louis Pasteur, 67300 Schiltigheim, France. Electronic address: victor.gabriele@chru-strasbourg.fr. 3. Department of Gynecologic Surgery, Centre Médico-Chirurgical Obstétrique, 19 Rue Louis Pasteur, 67300 Schiltigheim, France. Electronic address: aline.host@chru-strasbourg.fr. 4. Department of Gynecologic Surgery, Hôpital de Hautepierre, 1 Avenue Molière, 67200 Strasbourg, France. Electronic address: cherif.akladios@chru-strasbourg.fr. 5. Department of Gynecologic Surgery, Centre Médico-Chirurgical Obstétrique, 19 Rue Louis Pasteur, 67300 Schiltigheim, France. Electronic address: olivier.garbin@chru-strasbourg.fr. 6. Department of Gynecologic Surgery, Hôpital de Hautepierre, 1 Avenue Molière, 67200 Strasbourg, France; I-CUBE UMR 7357 - Laboratoire des Sciences de l'ingénieur, de l'Informatique et de l'imagerie, Université de Strasbourg, 67081 Strasbourg, France; Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, 67081, Strasbourg, France. Electronic address: lise.lecointre@chru-strasbourg.fr.
Abstract
OBJECTIVE: We aimed to present two cases of cesarean scar pregnancy (CSP) and a literature review to discuss their management. CASES: We reported two cases of cesarean scar pregnancy (CSP) treated in Strasbourg's University Hospital between 2016 and 2018 and carried out an updated literature review concerning their treatment. RESULTS: The first case is a superficial implantation CSP managed by methotrexate (MTX) then ligation of the uterine arteries and echo-guided aspiration. The second case is a deep implantation CSP managed by MTX and then laparoscopic excision with clamping of the uterine arteries. In the literature, the most commonly used treatments are: MTX, echo-guided aspiration, and the combination of uterine artery embolization followed by echo-guided aspiration. CONCLUSION: We established an algorithm in which CSP treatment by MTX can be considered alone if criteria are met. If not, surgery, chosen according to the depth of implantation, will be associated with MTX with a preventive hemostasis procedure by embolization or ligation of the uterine arteries.
OBJECTIVE: We aimed to present two cases of cesarean scar pregnancy (CSP) and a literature review to discuss their management. CASES: We reported two cases of cesarean scar pregnancy (CSP) treated in Strasbourg's University Hospital between 2016 and 2018 and carried out an updated literature review concerning their treatment. RESULTS: The first case is a superficial implantation CSP managed by methotrexate (MTX) then ligation of the uterine arteries and echo-guided aspiration. The second case is a deep implantation CSP managed by MTX and then laparoscopic excision with clamping of the uterine arteries. In the literature, the most commonly used treatments are: MTX, echo-guided aspiration, and the combination of uterine artery embolization followed by echo-guided aspiration. CONCLUSION: We established an algorithm in which CSP treatment by MTX can be considered alone if criteria are met. If not, surgery, chosen according to the depth of implantation, will be associated with MTX with a preventive hemostasis procedure by embolization or ligation of the uterine arteries.