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© 2008 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 27:779-783 • 0278-4297

Case Series

Role of Sonography in the Recognition, Assessment, and Treatment of Cesarean Scar Ectopic Pregnancies

David A. McKenna, MB, Liina Poder, MD, Mindy Goldman, MD and Ruth B. Goldstein, MD

Departments of Radiology (D.A.M., L.P., R.B.G.) and Obstetrics and Gynecology (M.G.), University of California, San Francisco, California USA.

Address correspondence to Liina Poder, MD, Department of Radiology, University of California, 505 Parnassus Ave, L-374, San Francisco, CA 94143-0628 USA.

Objective. Cesarean scar ectopic pregnancies (CSEPs) are rare but may have serious adverse consequences and are therefore important to promptly recognize on sonography. We aim to describe the typical sonographic appearances. Potential treatments are discussed, including sonographic guidance for transcervical injection of methotrexate (MTX) into the gestational sac. Methods. Two patients with CSEPs were treated with systemic and intra-amniotic administration of MTX under sonographic guidance. Results. Both patients were followed clinically after medical treatment, resulting in low maternal morbidity and mortality. Conclusions. Considering the increasing rate of cesarean delivery and the increased risk of CSEPs, sonologists should be familiar with the sonographic appearances of a pregnancy implanted into the cesarean scar. We show how to correctly diagnose scar implantation and describe how to perform sonographically guided transcervical injection of MTX.

Key Words: cesarean scar pregnancy • ectopic pregnancy • methotrexate • transvaginal sonography

Abbreviations: CSEP, cesarean scar ectopic pregnancy • hCG, human chorionic gonadotropin • IM, intramuscular • MTX, methotrexate

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Copyright © 2008 by the American Institute of Ultrasound in Medicine.