Management of cesarean scar pregnancy in the second trimester: a report of three cases.

ABSTRACT

BACKGROUND: A modern entity of the cesarean scar pregnancy with or without uterine dehiscence has been described and is increasing in incidence. Early diagnosis is difficult, and management in the second trimester poses a significant clinical challenge. The best options for management are unclear due to lack of data in this area. CASES Three women presented with cesarean scar pregnancy and underwent suction dilation and curettage (D&C) at 13, 13, and 14 weeks' gestation, respectively. One procedure was complicated by hematometra, and reevacuation was successful. The second and third cases resulted in hysterectomy due to uncontrollable hemorrhage after suction D&C, and pathology revealed pathologically adherent placenta in both cases. CONCLUSION: Intragestational sac methotrexate has not been reported at these later gestational ages for treatment of cesarean scar.pregnancies. D&C should be used judiciously in these patients due to the high risk of complications.