Reducing Bleeding in Cesarean Scar Pregnancy with Methotrexate: A Case Report

Abstract

Rising incidence of aggressive Cesarean Scar Pregnancy (CSP) lacks consensus treatment. This paper aims to evaluate the use of methotrexate in reducing bleeding in the management of CSP. Three cases of CSP, each managed with a distinct approach, are presented in this study. The first patient was diagnosed at 13 weeks of gestation. A hysterectomy was performed because of massive bleeding. The second patient had repeated CSP. The first CSP was diagnosed in six weeks, and curettage was performed. The patient had been bleeding for three months. CSP in the subsequent pregnancy was diagnosed at five weeks of gestational age, and the patient decided to terminate by systemic administration of methotrexate twice, followed by resection. Bleeding was minimal. Pregnant women must be screened as early as possible, especially in patients with a history of uterine wall injury, to rule out CSP. Methotrexate gives a better result for CSP management.

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