الفهرس 
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Abstract
A caesarean scar pregnancy (CSP) occurs when an embryo implants in the myometrium at the location of a prior caesarean section scar. The early detection of blastocyst invasion at ovarian incision scar epithelium is made possible by the rising prevalence of caesarean section and the widespread adoption of more accurate imaging techniques like tansvaginal sonogram, three-dimensional sonography, and magnetic resonance imaging. (MRI).
Life-threatening complications, including fetal implantation, postpartum hemorrhage, and significant haemorrhage, may occur if CSP is not treated successfully during the first trimester. Consequently, this causes the woman to lose her ability to have children and has serious, lasting negative impacts on her health and quality of life. Cesarean scar pregnancy is a common medical condition, and knowing how to properly diagnose it (as well as the differences between possible causes) is crucial, since the right treatment may have a significant impact on the patient’s recovery.
CSP may be handled in a number of different ways. On the other hand, there are no standard practises for handling CSPs. Surgical procedures such as dilatation and curettage (D&C), laparoscopy, hysteroscopy, injection of systemic or local MTX, and embolization of the uterine artery are all options for treating CSP (UAE).
For many years, MTX has been utilised as an initial treatment for ectopic pregnancies due to its ability to block the production of folic acid, which in turn blocks the production of new purines and pyrimidines and disrupts DNA synthesis and cell proliferation.
Ovum collection during in vitro fertilisation may be used to deliver a single local injection of MTX, eliminating the need for expensive or specialised equipment or procedures. However, there is still debate regarding whether or not local injection is more successful than systemic injection.
Several protocols for selection of candidates for medical treatment have been suggested, including those based on gestational weeks, presence of foetal cardiac activity, hemodynamic state, and serum ß-hCG level, among others, but it is generally accepted that medical treatment as the first line of defence requires additional surgical treatment.
The purpose of this research was to evaluate the safety, tolerability, and effectiveness of MTX injections for the treatment of ceaserean scars during pregnancy.
Patients with CSP who were seen by our obstetrics and gynaecology staff at Minia maternity and children’s university hospital between 2022 and 2023 were included in this prospective research. Standard sonographic criteria were used to make a diagnosis of CSP. Our hospital’s standard procedure for treating CSP was vacuum evacuation followed by MTX treatment.
Important findings included a mean body mass index of 28.43 kg/m2 and an age range of 25-40 years. Some patients (43.3%) were from rural areas, while the remaining 56.7% were from metropolitan areas. Average body mass index was 5.83 2.23 and average parity was 3.77 1.94. Parity was mean 15.6 6.5 mm and GA was mean 5.83 2.23 weeks. Patients with endometriosis were more likely to present with a type 1 gestational sac, whereas patients with ectopic pregnancy were more likely to present with a type 2 gestational sac. Three-quarters of the patients had already had two D&C procedures, while another 23.3 percent had undergone one D&C and 10% had undergone four. One patient had hypothyroidism and two others had rheumatoid arthritis. Half of the women had a positive hyper-vascular signal, whereas 60% had vaginal bleeding, 23.3% had stomach discomfort, and 6.7% had a foetal heartbeat. The average first-time hCG level was 31367.9 26764.7 mIU/ml, and the average number of days to return to normal was 52.86 22.49. The mean duration of treatment success was 57.22 17.67 days, with 90% of patients showing improvement. In terms of age, body mass index, pregnancy, and parity, there is no statistically significant difference between treatment success and failure individuals. A large disparity exists between treatment success and failure patients with regards to initial -hCG. Dilatation and curettage results have been drastically different for those who were successful and those who were not.
The Our findings suggest the need for bigger patient populations and extended follow-up in future investigations.