Diagnostic value of transvaginal color Doppler ultrasonography findings in post treatment follow up of cesarean scar pregnancy

Aim: Cesarean scar pregnancy can cause life-threatening complications for pregnant women, so early diagnosis and treatment is crucial for prevention of maternal mortality. Transvaginal color Doppler ultrasonography besides serum β-hCG level follow-up can be a noninvasive and proper method for post-treatment follow-up of a cesarean scar pregnancy. In the present study, we investigated the Doppler resistance index changes in cesarean scar pregnancies after medical management together with sac diameter and serum β-hCG level measurement. Methods: 28 patients with cesarean scar pregnancy and a history of previous cesarean delivery, gestational age of less than 9 completed weeks at ultrasonography, decision to medical management by gynecologist and with having a β-hCG level before treatment were enrolled and initially examined by ultrasound and Doppler studies. The resistance index of the closest myometrial artery to cesarean scar pregnancy mass and its diameter were measured. After 72 hours, 1 week and 2 weeks after medical therapy, mentioned variables were measured again and were compared to the values of the pretreatment time point. Results: Resistance index values were significantly higher in all of the follow-up time points compared with the pretreatment time points, while serum β-hCG levels were significantly lower. Moreover, sac diameter values were increased 72 hours post-treatment and then declined. Conclusions: Serial Doppler ultrasound examinations can be a useful method to evaluate the success or failure of medical management of cesarean scar pregnancies as the increase in resistance index values occur rapidly after medical treatment and correlate well with serum β-hCG levels.