Prevalence, symptoms, risk factors and management of caesarean scar ectopic pregnancy

Abstract

The aim of this study is to estimation the prevalence, symptoms, risk factors and management of caesarean scar ectopic pregnancy. Materials and Methods: This study was a cross-sectional study and the target population consisted of all pregnant mothers who were diagnosed with caesarean scar ectopic pregnancy, which was performed on ultrasound and approved by a trained radiologist and were admitted to Al-Zahra Hospital from 2014 to 2019. Sampling was census. Findings were extracted from the records of hospitalized patients after receiving the code of ethics. Results: The prevalence of caesarean scar ectopic pregnancy was 0.23 among all ectopic pregnancies and the prevalence of caesarean scar ectopic pregnancy was 3.22 among all ectopic pregnancies. In this study, the number of caesarean scar ectopic pregnancy had increased in the order of the year, which the highest number of data belonged to the year 2019 with 44 cases (31%). In this study, the mean (standard deviation) age of the subjects was 34.57 (±4.9) years. The mean (SD) gestational age of the subjects was 6.74 (±1.9) months. The most of frequency of the subjects was in 2018-19 with 44 patients (31.0%). The median (25th and 75th percentiles) HCG at admission in these patients was 4,000 (2449-10,000) mIU / mL. The median (25th and 75th percentiles) of sack size and CRL in sonographic findings in these subjects were 10.0 (6.0-17.5) and 6.3 (3.5-12.8) mm, respectively. The most symptoms for caesarean scar ectopic pregnancy in this study were vaginal bleeding and abdominal pain with 82 cases (57.7%) and 73 cases (51.4%), respectively. Also, the most risk factors for caesarean scar ectopic pregnancy in this study were history of abortion, history of one cesarean section and history of two cesarean sections with 76 cases (53.5%), 72 cases (50.7%) and 54 cases (50.7%), respectively. The most method of treatment for caesarean scar ectopic pregnancy in this study were dilatation and curettage, treatment with systemic methotrexate and topical kcl treatment + systemic methotrexate with 61 cases (43.0%), 52 cases (36.6%) and 39 cases (27.5%), respectively. The most outcome for caesarean scar ectopic pregnancy in these patients was readmission and extensive hemorrhage with 31 cases (21.8%) and 27 cases (19.0%), respectively. In addition, unfortunately, it resulted in hysterectomy in 4 cases (2.8%).