1
|
Karakuş R, Karakuş SS, Güler B, Ünver G, Özkaya E. Myometrial thickness overlying cesarean scar pregnancy is significantly associated with isthmocele formation in the third month of the postoperative period. Turk J Obstet Gynecol 2021; 18:37-43. [PMID: 33715331 PMCID: PMC7962161 DOI: 10.4274/tjod.galenos.2021.65288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: To determine some associated factors for isthmocele formation 3 months after the treatment of cesarean scar pregnancy (CSP). Materials and Methods: This is a prospective consecutive case series of CSP managed by fertility preservation modalities at a single tertiary care center from May 2016 to March 2019 (n=95). Patients with a diagnosis of CSP were identified and followed prospectively to collect data on the patients’ demographics; detailed medical, surgical, and social history; symptoms; imaging and laboratory parameters at the time of CSP diagnosis and during treatment; treatment modalities, myometrial thickness; and outcomes in terms of isthmocele formation. Results: Mean myometrial thickness overlying scar pregnancy was significantly lower in the group with isthmocele formation, and the mean gestational age of scar pregnancy was also significantly lower in the group with isthmocele formation following treatment of scar pregnancy (p<0.05). Multivariate regression analysis was conducted to determine associations between certain variables and isthmocele development, which revealed that the gestational age of scar pregnancy and myometrial thickness were significantly associated with isthmocele formation. Conclusion: Myometrial thickness and gestational age of scar pregnancy were significantly associated with isthmocele formation 3 months after treatment.
Collapse
Affiliation(s)
- Resul Karakuş
- University of Health Sciences Turkey, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Sultan Seren Karakuş
- University of Health Sciences Turkey, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Burak Güler
- University of Health Sciences Turkey, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Gökhan Ünver
- University of Health Sciences Turkey, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Enis Özkaya
- University of Health Sciences Turkey, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| |
Collapse
|
2
|
Cesarean Section Scar Ectopic Pregnancy in the Second Trimester: An Underrecognized Complication of Cesarean Deliveries. Case Rep Obstet Gynecol 2021; 2021:8888019. [PMID: 33628549 PMCID: PMC7886503 DOI: 10.1155/2021/8888019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/15/2020] [Accepted: 11/30/2020] [Indexed: 11/17/2022] Open
Abstract
The aim of this paper is to present a case of a cesarean section ectopic pregnancy (CSP) diagnosed in the second trimester and perform a literature review of current guidelines for the management of CSP in the second trimester. This was exempt from the Mount Sinai IRB. This is a case is of a 35-year-old P1122 at 13w4d who presented to our hospital with vaginal spotting and abdominal pain. The patient was found to have a cesarean section ectopic pregnancy with placenta increta. There are no management guidelines for second trimester CSP, and the published material is minimal. A literature review was completed and demonstrated two cases and one case series published on management of existing literature on management of second trimester CSP. Our patient underwent an uncomplicated total laparoscopic hysterectomy with bilateral salpingectomy, bilateral ureterolysis, and cystoscopy. She had an uncomplicated postoperative course and was discharged on postoperative day three with an unremarkable recovery at her two-week postoperative visit.
Collapse
|
3
|
Ureña N, de la Ossa K, Reyes O. Embarazo ectópico en cicatriz de cesárea previa: reporte de un caso y revisión de la literatura. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2015. [DOI: 10.1016/j.gine.2014.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
4
|
Cesarean scar ectopic pregnancy: imaging features, current treatment options, and clinical outcomes. ACTA ACUST UNITED AC 2015; 40:2589-99. [DOI: 10.1007/s00261-015-0472-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
5
|
Jurkovic D. Cesarean scar pregnancy and placenta accreta. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:361-362. [PMID: 24692219 DOI: 10.1002/uog.13346] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- D Jurkovic
- Department of Obstetrics and Gynaecology, University College Hospital, London, UK.
| |
Collapse
|
6
|
Kelekçi S, Aydoğmuş S, Aydoğmuş H, Eriş S, Demirel E, Şen Selim H. Ineffectual Medical Treatment of Cesarean Scar Ectopic Pregnancy With Systemic Methotrexate: A Report of Two Cases. J Investig Med High Impact Case Rep 2014; 2:2324709614528903. [PMID: 26425599 PMCID: PMC4528867 DOI: 10.1177/2324709614528903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The implantation of a pregnancy within the scar of a previous cesarean section is known as a “cesarean scar pregnancy.” Its incidence was reported to be 6.1%. However, with the increasing rates of cesarean sections, the incidence is expected to rise. A variety of conservative and surgical treatment modalities have been proposed for the management of cesarean scar pregnancy; however, there are no optimal universal treatment guidelines because of its rarity. Treatment should be tailored to the individual patient. It is obvious that more scar pregnancies will be seen in the future and therefore a set of criteria for the choice of various modes of management should be developed. Here, we present 2 cases of cesarean scar pregnancies treated with a local injection of potassium chloride after the failure of methotrexate administration.
Collapse
Affiliation(s)
- Sefa Kelekçi
- Katip Çelebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Serpil Aydoğmuş
- Katip Çelebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Hüseyin Aydoğmuş
- Katip Çelebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Serenat Eriş
- Katip Çelebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Emine Demirel
- Katip Çelebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Halime Şen Selim
- Katip Çelebi University Ataturk Training and Research Hospital, Izmir, Turkey
| |
Collapse
|
7
|
Timor-Tritsch IE, Monteagudo A. Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy. A review. Am J Obstet Gynecol 2012; 207:14-29. [PMID: 22516620 DOI: 10.1016/j.ajog.2012.03.007] [Citation(s) in RCA: 366] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 01/28/2012] [Accepted: 03/09/2012] [Indexed: 11/29/2022]
Abstract
This review concentrates on 2 consequences of cesarean deliveries that may occur in a subsequent pregnancy. They are the pathologically adherent placenta and the cesarean scar pregnancy. We explored their clinical and diagnostic as well as therapeutic similarities. We reviewed the literature concerning the occurrence of early placenta accreta and cesarean section scar pregnancy. The review resulted in several conclusions: (1) the diagnosis of placenta accreta and cesarean scar pregnancy is difficult; (2) transvaginal ultrasound seems to be the best diagnostic tool to establish the diagnosis; (3) an early and correct diagnosis may prevent some of their complications; (4) curettage and systemic methotrexate therapy and embolization as single treatments should be avoided if possible; and (5) in the case of cesarean scar pregnancy, local methotrexate- and hysteroscopic-directed procedures had the lowest complication rates.
Collapse
Affiliation(s)
- Ilan E Timor-Tritsch
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY 10016, USA.
| | | |
Collapse
|
8
|
Fylstra DL. Ectopic pregnancy not within the (distal) fallopian tube: etiology, diagnosis, and treatment. Am J Obstet Gynecol 2012; 206:289-99. [PMID: 22177188 DOI: 10.1016/j.ajog.2011.10.857] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 09/29/2011] [Accepted: 10/16/2011] [Indexed: 12/16/2022]
Abstract
Ectopic pregnancy is a very common diagnosis (2% of pregnancies), and implantation location varies. Although 97% of ectopics are implanted within the fallopian tube, associated with commonly recognized risk factors, ectopic implantation can occur in other pelvic and abdominal locations that may not have such predisposing risk factors. After an extensive review of the literature, along with the author's personal experience, implantation frequency, etiologic possibilities, and treatment options for each ectopic pregnancy location are presented. When ectopic pregnancy is diagnosed early, before rupture, regardless of location, conservative, fertility-sparing treatment options can be successful in terminating the pregnancy. Predisposing risk factors and treatment options can vary and can be ectopic-location specific.
Collapse
Affiliation(s)
- Donald L Fylstra
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
9
|
Ebner F, Hanna N, Petrich S, Paterson H. Caesarean scar pregnancy at 19 weeks gestation. Australas J Ultrasound Med 2011; 14:31-33. [PMID: 28191118 PMCID: PMC5024898 DOI: 10.1002/j.2205-0140.2011.tb00121.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Due to the increased numbers of caesarean sections in the last decade, women with a caesarean section scar in pregnancy are becoming more commonly diagnosed using ultrasound. One of the rare but more severe complications of this is an implantation of the pregnancy in the caesarean section scar.
Collapse
Affiliation(s)
- Florian Ebner
- Diakonieklinikum Schwaebisch HallGermany; Women's Health Dunedin HospitalDunedinNew Zealand
| | - Nadar Hanna
- Women's Health Dunedin Hospital Dunedin New Zealand
| | | | - Helen Paterson
- Department of Women's and Children's Health Dunedin School of Medicine University of Otago Dunedin North New Zealand
| |
Collapse
|
10
|
Hysteroscopic management of cesarean scar ectopic pregnancy. Fertil Steril 2010; 93:1735-40. [DOI: 10.1016/j.fertnstert.2008.12.099] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 12/18/2008] [Accepted: 12/18/2008] [Indexed: 11/30/2022]
|
11
|
Sum TK, Wong SH, Tai CM, Ng TK. An ectopic pregnancy in a previous caesarean section scar: treatment with systemic methotrexate and uterine artery embolisation. J OBSTET GYNAECOL 2009; 20:328. [PMID: 15512574 DOI: 10.1080/01443610050009836] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- T K Sum
- Obstetrics and Gynaecology Unit, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | | | | | | |
Collapse
|
12
|
Rana A, Gurung G, Rawal S, Bista KD, Adhukari S, Ghimire RK. Surviving 27 weeks fetus expelled out of the ruptured rudimentary horn and detected a month later as a secondary abdominal pregnancy. J Obstet Gynaecol Res 2008; 34:247-51. [DOI: 10.1111/j.1447-0756.2008.00763.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
13
|
Özkan S, Çalışkan E, Özeren S, Çorakçı A, Çakıroğlu Y, Coşkun E. Three-dimensional ultrasonographic diagnosis and hysteroscopic management of a viable cesarean scar ectopic pregnancy. J Obstet Gynaecol Res 2007; 33:873-7. [DOI: 10.1111/j.1447-0756.2007.00671.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
14
|
Flye Sainte Marie H, Baudo M, Benezech C, Deutsch V, Tournadre D, Hoffmann P, Schaal JP. Prise en charge obstétricale après grossesse ectopique intracicatricielle: à propos d'un cas et revue de la littérature. ACTA ACUST UNITED AC 2007; 36:503-6. [PMID: 17498891 DOI: 10.1016/j.jgyn.2007.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Revised: 02/05/2007] [Accepted: 03/14/2007] [Indexed: 10/28/2022]
Abstract
We report the case of a patient who came out pregnancy twelve months after medical and surgical treatment of an ectopic pregnancy in a previous caesarean section scar. The preconceptional management consisted in a saline infusion sonohysterography and a pelvic magnetic resonance imaging. Judging the risks of abnormal placental insertion to be higher in this case compared to a simple caesarean section, a careful ultrasonography with color doppler imaging was carried out. The myometrium fragility caused by the ectopic pregnancy in the caesarean section brought us to recommend a prophylactic caesarean section around 37. The high risks of hemorrhage required a medical center with embolization possibilities. A review of literature in order to define the medical care adapted in this case was come out.
Collapse
Affiliation(s)
- H Flye Sainte Marie
- Service de gynécologie-obstétrique, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France
| | | | | | | | | | | | | |
Collapse
|
15
|
Fernandez H. Grossesse isthmique localisée au niveau d'une cicatrice d'hystérotomie traitée par méthotréxate. À propos d'un cas. ACTA ACUST UNITED AC 2006; 34:181. [PMID: 16495114 DOI: 10.1016/j.gyobfe.2006.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
16
|
Lim YY, Hsu CY, Chen CP. Methotrexate Followed by Suctional Curettage: A Successful Treatment for Cesarean Scar Pregnancy. Taiwan J Obstet Gynecol 2005. [DOI: 10.1016/s1028-4559(09)60132-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
17
|
Wang YL, Su TH, Chen HS. Laparoscopic management of an ectopic pregnancy in a lower segment cesarean section scar: A review and case report. J Minim Invasive Gynecol 2005; 12:73-9. [PMID: 15904604 DOI: 10.1016/j.jmig.2004.12.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Implantation of a pregnancy within the scar of a previous cesarean delivery is the rarest of ectopic pregnancy locations, with only 32 cases reported in the English-language medical literature. A 28-year-old woman was admitted to our institution with a suspected ectopic pregnancy located in the scar from a previous cesarean section. Ultrasound revealed a well-encapsulated, bulging mass with a gestational sac within the anterior uterine isthmus in the site of an old cesarean delivery scar. Laparoscopy was performed to confirm the diagnosis, and the gestational products also were removed laparoscopically. The defect in the uterus was then repaired by suturing. Total operative time was 120 minutes, blood loss was limited, and no transfusion was needed. Laparoscopy may be a reasonable alternative to laparotomy for an unruptured ectopic pregnancy in a cesarean scar.
Collapse
Affiliation(s)
- Yeou-Lih Wang
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and Mackay Medicine, Nursing and Management College, Taipei, Taiwan
| | | | | |
Collapse
|
18
|
Seow KM, Hwang JL, Tsai YL, Huang LW, Lin YH, Hsieh BC. Subsequent pregnancy outcome after conservative treatment of a previous cesarean scar pregnancy. Acta Obstet Gynecol Scand 2004; 83:1167-72. [PMID: 15548150 DOI: 10.1111/j.0001-6349.2004.00445.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND To assess pregnancy course and outcome after conservative treatment of a cesarean scar pregnancy. METHODS During an 8-year period, 15 cases of cesarean scar pregnancies were diagnosed at our institution. Seven of the 14 patients for whom we successfully preserved the uterus became pregnant within 3 years after termination of the scar pregnancy. The year of diagnosis, conservative method and gestational age for these five patients were recorded. Delivery method, time interval between the scar pregnancy and subsequent pregnancy, and maternal and neonatal outcome were evaluated. RESULTS Seven pregnancies (eight live and one dead baby) were noted. The mean interval between the ectopic pregnancy and subsequent pregnancy was 13.3 months (range 0-34 months). One patient, who became pregnant 3 months after the scar pregnancy was found, suffered uterine rupture at 38.3 weeks' gestational age. Two patients with placental accrete, and one of them who continued the existing intrauterine twin pregnancy after transvaginal sono-guided aspiration of the scar pregnancy received a cesarean hysterectomy at 32 weeks of gestation. The remaining four pregnancies were uneventful, followed by early cesarean sections at 36 weeks. CONCLUSION The results of this first series of seven subsequent pregnancies after conservative treatment of scar pregnancies are promising. An early cesarean section before over-extension of the uterus and spontaneous labor can help to prevent uterine rupture. Placenta accrete is another severe morbidity of these patients in addition to uterine rupture. Thus a cesarean hysterectomy may be the choice of treatment.
Collapse
Affiliation(s)
- Kok-Min Seow
- Department of Obstetrics and Gynecology, Shin-Kong Wu-Ho-Su Memorial Hospital, Taipei, Taiwan
| | | | | | | | | | | |
Collapse
|
19
|
Chuang J, Seow KM, Cheng WC, Tsai YL, Hwang JL. Conservative treatment of ectopic pregnancy in a caesarean section scar. BJOG 2003. [DOI: 10.1111/j.1471-0528.2003.02117.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
20
|
Salomon LJ, Fernandez H, Chauveaud A, Doumerc S, Frydman R. Successful management of a heterotopic Caesarean scar pregnancy: potassium chloride injection with preservation of the intrauterine gestation: case report. Hum Reprod 2003; 18:189-91. [PMID: 12525465 DOI: 10.1093/humrep/deg010] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Caesarean scar pregnancy (CSP), in which the pregnancy is located in the scar of a previous Caesarean section, is a rare situation that carries a high risk of uterine rupture. Improved ultrasound imaging allows early diagnosis of this condition, but there is no standard management. We report the first case of CSP associated with a normal intrauterine pregnancy. Potassium chloride administered under transvaginal ultrasonographic guidance terminated cardiac activity in the CSP. The CSP resolved, and a healthy infant was delivered at 36 weeks. When the diagnosis is early and the patient asymptomatic, surgery can be avoided, the CSP can be terminated selectively and the intrauterine pregnancy thereby preserved.
Collapse
Affiliation(s)
- L J Salomon
- Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, Assistance Publique-Hôpitaux de Paris (AP-HP), 157 rue de la Porte-de-Trivaux, 92140 Clamart, France
| | | | | | | | | |
Collapse
|
21
|
Levine D. Placenta percreta versus ectopic pregnancy. AJR Am J Roentgenol 2003; 180:284; author reply 284. [PMID: 12490523 DOI: 10.2214/ajr.180.1.1800284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
22
|
Abstract
Implantation of a pregnancy within the scar of a previous cesarean delivery is the rarest of ectopic pregnancy locations. Only 19 cases have been reported in the English medical literature since 1966. If diagnosed early, treatment options are capable of preserving the uterus and subsequent fertility. However, a delay in either diagnosis or treatment can lead to uterine rupture, hysterectomy, and significant maternal morbidity. Although expectant and medical managements have been reported, termination of a cesarean scar pregnancy by laparotomy and hysterotomy, with repair of the accompanying uterine scar dehiscence, may be the best treatment option.
Collapse
|
23
|
Haimov-Kochman R, Sciaky-Tamir Y, Yanai N, Yagel S. Conservative management of two ectopic pregnancies implanted in previous uterine scars. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2002; 19:616-619. [PMID: 12047544 DOI: 10.1046/j.1469-0705.2002.00719.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Cesarean section scar pregnancy is rare. A variety of interventions have been implemented to terminate the pregnancy and preserve the uterus; however, the optimal treatment is unknown. We describe two cases of this rare condition diagnosed by transvaginal ultrasound. In the first case the diagnosis of an 8-week non-viable gestation in a uterine scar was made sonographically in a 40-year-old woman. The patient was treated with intramuscular methotrexate. Myometrial integrity was suggested both by ultrasound findings and laparoscopic findings. In the second case, an early cervicoisthmic pregnancy in a uterine scar was diagnosed by sonography in a 39-year-old woman. This patient was treated successfully with a full course of intramuscular methotrexate. Complete disappearance of the gestational sac took place 4 months following beta-human chorionic gonadotrophin normalization. Intramuscular methotrexate may be a treatment alternative for Cesarean section scar pregnancies.
Collapse
Affiliation(s)
- R Haimov-Kochman
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel.
| | | | | | | |
Collapse
|
24
|
Seow KM, Hwang JL, Tsai YL. Ultrasound diagnosis of a pregnancy in a Cesarean section scar. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2001; 18:547-549. [PMID: 11844184 DOI: 10.1046/j.0960-7692.2001.00569.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
|
25
|
Nawroth F, Foth D, Wilhelm L, Schmidt T, Warm M, Römer T. Conservative treatment of ectopic pregnancy in a cesarean section scar with methotrexate: a case report. Eur J Obstet Gynecol Reprod Biol 2001; 99:135-7. [PMID: 11604205 DOI: 10.1016/s0301-2115(01)00365-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Ectopic pregnancies sited in dehiscent cesarean section scars have a high risk of rupture and bleeding. Attempts at operative therapy frequently end in loss of the uterus. A connection with the cavum uteri justifies an attempt at dilatation and curettage. We describes a patient with combined systemic and local intra-amniotic methotrexate (MTX). The uterus was preserved.
Collapse
Affiliation(s)
- F Nawroth
- Department of Obstetrics and Gynaecology, University of Cologne, Kerpener Str. 34, 50931 Cologne, Germany.
| | | | | | | | | | | |
Collapse
|
26
|
Ayoubi JM, Fanchin R, Meddoun M, Fernandez H, Pons JC. Conservative treatment of complicated cesarean scar pregnancy. Acta Obstet Gynecol Scand 2001. [DOI: 10.1034/j.1600-0412.2001.080005469.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
27
|
Georgoulopoulos A, Steiner H, Wienerroither H, Staudach A. An Unusual Presentation of Abdominal Pregnancy Managed by Laparoscopy. J Gynecol Surg 2001. [DOI: 10.1089/104240601750200369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
| | - Horst Steiner
- Department of Obstetrics and Gynecology, General Hospital Salzburg, Salzburg, Austria
| | | | - Alfons Staudach
- Department of Obstetrics and Gynecology, General Hospital Salzburg, Salzburg, Austria
| |
Collapse
|
28
|
INTERMENSTRUAL BLEEDING SECONDARY TO CESAREAN SCAR DIVERTICULI. Obstet Gynecol 1999. [DOI: 10.1097/00006250-199905001-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|