Control Bleeding of Ectopic partial Molar Pregnancy in the Cesarean Scar with Embolization of Uterine Artery

Introduction: Molar pregnancy is a fetal trophoblastic disease that, it often happens in the uterus but rarely occurs in the other places, especially in previous cesarean scars, diagnosis and treatment of this matter is controversial. In some studies, the prevalence of this problem was reported One in a million pregnancies.We report is a case of molar pregnancy at cesarean section scar that treated with a combination of methotrexate and uterine artery embolization.Case report: A 34-year-old multiparous female patient with two previous cesarean sections who has referred due to complained of abnormal uterine bleeding and pain.BhCG at the first day was 118000 IU/L. vaginal ultrasound reported pregnancy in the lower uterus with 7W+5d age, heart rate and several cystic areas adjacent to the fetus that The myometrium between the sac and the bladder was very thin, about 1.2 mm (Fig1) In order to initially KCL injected in the fetus, the heart rate disappeared and then the intramuscular methotrexate and oral Leucovorin were order for eight-day period. Then, with the reduction of BhCG on day 8, 52,000 IU / L patients were discharged and followed up.One week after discharge due to intra-peritoneal hemorrhage for, patient had due uterine artery embolization and bleeding was controlled. Then follow up on the patient BHCG titer there was a decline trend and finally was negative.Conclusion: Molar pregnancy is rare in cesarean section scar and it has the risk of bleeding and rupture of the uterus. However, evidence for the best treatment for molar pregnancy in cesarean section scar is controversial, such as intrauterine methotrexate injection, curettage suction, uterine artery embolization with curettage suction have been reported in studies. The recently treatment reported with methotrexate and uterine artery embolization that s done successfully.

کلیدواژه ها:

Ectopic partial molar pregnancy ، cesarean scar ، embolization of uterine artery.