A retrospective review of uterine scar pregnancies: single centre experience

Our aim was to present our experience with the management of six women with uterine scar pregnancies in KK Women's and Children's Hospital, Singapore. The medical records of women with a pregnancy in previous uterine scar that had been diagnosed in our department during 2004-2008 were reviewed. Out of six women, one woman presented in mid-trimester, at 16 weeks with severe abdominal pain and persistent vomiting. She underwent a hysterectomy complicated with massive haemorrhage. The other five women presented in first trimester. Two women had excision of the scar with the sac, two had ultrasound-guided injection of methotrexate in the sac and one had systemic methotrexate. In all cases, maternal recovery was complete. Uterine scar pregnancy was diagnosed by ultrasonography. Women at a risk appear to be those with multiple Caesarean sections, termination of pregnancy and myomectomy. Operative as well as medical treatments have been reported for scar pregnancy. Surgical treatment includes excision of trophoblastic tissues by laparotomy or laparoscopy whilst medical treatment includes local and/or systemically administered methotrexate. Although many interventions have been described, optimal treatment is still not known and they remain a challenge.