Caesarean scar pregnancy. Analysis of medical intragestational therapy in a cohort of 35 patients

Introduction
Pregnancy in a scar after caesarean section (CSP) is a rare complication associated with the risk of morbidly adherent placenta (MAP) and adverse outcomes. The management of CSP is evolving, with various surgical and medical approaches employed.

Aim of the research
To analyse the outcomes of 35 cases of CSP and their treatment modalities.

Material and methods
Medical records of patients hospitalized at a single institution were reviewed. Data on patient characteristics, gestational age, treatment methods, hospitalization length, complications, and rehospitalization rates were collected. Statistical analysis was conducted using nonparametric Spearman correlation.

Results
The study included 35 CSP patients with a mean age of 33 years. The median gestational age at diagnosis was 6 weeks. Methotrexate (MTX) administration to the gestational sac, alone or with intragestational MTX injection, was the primary treatment method. The median length of hospitalization was 6 days. No significant correlation was found between hospital stay and patient age, number of previous caesarean sections, or pre-procedure b-human chorionic gonadotropin (b-HCG) levels. Spontaneous evacuation occurred in most cases, with only a minority requiring subsequent uterine evacuation. No significant complications occurred, but 1 patient experienced heavy bleeding requiring a blood transfusion.

Conclusions
Intra-amniotic MTX administration, combined with potassium chloride in certain cases, was found to be an effective and safe approach for managing CSP in the first trimester. This study contributes to the understanding of CSP management and supports the use of intra-amniotic MTX as a minimally invasive treatment option. Further research is needed to refine management guidelines and improve outcomes for this rare complication.