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Table 3 Management, complications, and surveillance of the 6 patients diagnosed with CSP included in the case-series report

From: Combination of medical and surgical management in successful treatment of caesarean scar pregnancy: a case report series

Patient

Initial treatment

Complications

Management of complications

Hospitalisation

(days)

Imagistic surveillance:

TVUS and color Doppler

hCG surveillance

1

Medical: Methotrexate

1 mg/kg, 5 doses, alternate days

No complications, spontaneous resolution of pregnancy

N/A

9

3-months posttreatment: normal uterus and isthmic caesarean scar

98 days follow up until negative

2

Medical:

Methotrexate

1 mg/kg, 5 doses, alternate days

Increase hCG levels

Persistence of pregnancy and local trophoblastic vascularization

Surgical: D&C and local haemostasis with Foley catheter for 48 h

11

still on surveillance

Decreasing trend of hCG

3

Medical:

Mifepristone,

Methotrexate, 1 mg/kg

Increase hCG levels

Spontaneous miscarriage with heavy vaginal bleeding

Surgical, D&C under US guidance

haemostasis with uterine-vaginal pack

13

6-months post treatment: normal uterus and uterine scar

< 10

4

Medical:

Mifepristone, Methotrexate, 1 mg/kg

No complications, spontaneous resolution of pregnancy

N/A

10

1-month post treatment

Normal uterus and uterine scar

<  5

5

Surgical: D&C

Persistence of vascularised trophoblast

Medical: Methotrexate, 1 mg/kg x 1dose

Surgical: D&C and haemostasis with Foley catheter

11

2-years posttreatment

Normal appearance of anterior wall of the uterus normal and caesarean scar

Follow up another centre

6

Surgical:

emergency D&C

Spontaneous miscarriage with heavy vaginal bleeding Persistence of pregnancy, presence of isthmic mass with rich vascularization and possible accreta

Surgical: D&C haemostasis Foley catheter & blood transfusion

Surgical: Total abdominal hysterectomy

9

N/A

<  64 mUI/mL

  1. Abbreviations: CSP caesarean section scar, hCG hormone chorionic gonadotroph, N/A not applicable. Hospitalization days counts all days as inpatient until treatment completed and discharged to surveillance