scholarly journals A Scary Complication: Single-center Study on Management and Outcome of Cesarean Scar Pregnancy

2021 ◽  
Vol 43 (04) ◽  
pp. 311-316
Author(s):  
Beate Hüner ◽  
Krisztian Lato ◽  
Frank Reister ◽  
Wolfgang Janni ◽  
Miriam Deniz
Keyword(s):  
Treatment Options ◽  
Hypovolemic Shock ◽  
Severe Bleeding ◽  
Daily Routine ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Life Threatening ◽  
Progressive Growth ◽  
Emergency Hysterectomy ◽  
Ectopic Pregnancies

AbstractA cesarean scar pregnancy (CSP) is a scary and life-threatening complication of cesarean section (CS). Nevertheless, the incidence of CS is constantly growing. The CSP incidence is 0,15% of pregnancies after CS which represents 6,1% of all ectopic pregnancies in women with condition after CS. Therefore, it should be more present in the clinical daily routine. From mild nonspecific symptoms to hypovolemic shock, diagnosis and therapy must be performed quickly. With the progressive growth of the scar pregnancy, a uterine rupture involves the risk of severe bleeding, and an emergency hysterectomy could be necessary. Prolongation of pregnancy has been successful only in a few cases. We report 11 cases from our hospital in the past 10 years. In the discussion, treatment options of this complication with an increasing incidence, which is associated with serious morbidity and mortality, are presented based on the current literature. Treatment options include drug therapy, but also surgical or combined procedures with radiological intervention.

scholarly journals Ruptured Cesarean Scar Pregnancy: A Case Report

2019 ◽  
Vol 57 (217) ◽  
Author(s):  
Prishita Shah ◽  
Rosina Manandhar ◽  
Meena Thapa ◽  
Rachana Saha
Keyword(s):  
Case Report ◽  
Uterine Rupture ◽  
First Trimester ◽  
Emergency Laparotomy ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Maternal Morbidity And Mortality ◽  
Subsequent Loss ◽  
Ectopic Pregnancies ◽  
Previous Cesarean

Cesarean scar pregnancy is a rare variant of ectopic pregnancy where the fertilized ovum gets implanted in the myometrium of the previous cesarean scar. The incidence of CSP among ectopic pregnancies is 6.1% and it is seen in approximately 1 in 2000 normal pregnancies.As trophoblastic invasion of the myometrium can result in uterine rupture and catastrophic hemorrhage termination of pregnancy is the treatment of choice if diagnosed in the first trimester. Expectant treatment has a poor prognosis and may lead to uterine rupture which may require hysterectomy and subsequent loss of fertility. We present a case report of a 24year old femaleG2P1L1with ruptured cesarean scar pregnancy who underwent emergency laparotomy and subsequently hysterectomy. In this case report, we aim to discuss ruptured cesarean scar pregnancy as obstetric emergency and methods by which we can make an early diagnosis that can be managed appropriately as to prevent maternal morbidity and mortality.

Analysis of the efficacy of three treatment options for cesarean scar pregnancy management

2014 ◽  
Vol 40 (11) ◽  
pp. 2146-2151 ◽  
Author(s):  
Yue-ran Li ◽  
Song-shu Xiao ◽  
Ya-jun Wan ◽  
Min Xue
Keyword(s):  
Treatment Options ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar

scholarly journals Cesarean Scar Pregnancy - A Rare Entity: Two Case reports

2018 ◽  
Vol 2 (3) ◽  
pp. 312-315
Author(s):  
Krishna Mahato ◽  
Yu Bin
Keyword(s):  
Maternal Morbidity ◽  
Case Reports ◽  
Rare Entity ◽  
Ultrasound Guided ◽  
Management Options ◽  
Cesarean Scar Pregnancy ◽  
Major Hemorrhage ◽  
Cesarean Scar ◽  
Presenting Symptoms ◽  
Life Threatening

Cesarean scar pregnancy is the implantation of an embryo within the mymometrium of prior cesarean scar which is a rare variant of ectopic pregnancy. Such implantation is life threatening leading to uterine rupture, extensive hemorrhage and serious maternal morbidity. Making an early diagnosis minimizes risk of such major hemorrhage thus preserving the uterus and further fertility. In this case report we discuss two different management options: ultrasound guided intragestational methotrexate injection with sac aspiration; and transvaginal hysterotomy considering the severity of presenting symptoms. Birat Journal of Health SciencesVol.2/No.3/Issue 4/Sep- Dec 2017, Page: 312-315

scholarly journals Live Cesarean Scar Pregnancy: A Case Report

2020 ◽  
pp. 1-4
Author(s):  
Zohra Amin ◽  
Anu Dua ◽  
Arzoo Amin ◽  
Zohra Amin
Keyword(s):  
Surgical Management ◽  
Medical Management ◽  
Cesarean Scar Pregnancy ◽  
Initial Management ◽  
Cesarean Scar ◽  
Threatening Condition ◽  
Life Threatening ◽  
Specific Symptoms ◽  
Previous Cesarean

Introduction: The overall incidence of Cesarean scar pregnancy is increasing due to Cesarean rates. This life-threatening condition has been historically managed in various ways as no single modality is reliable enough. We report this case of live CSP managed initially with Fetocide followed by Methotrexate but requiring Surgical management later on. Presentation: A 32 years old para 5 with four previous Cesarean sections was diagnosed with live CSP. HCG level was 76,619. The initial management was fetocide with KCL followed by Methotrexate. The treatment was considered successful in view of appropriate reduction in serum HCG levels. The woman required surgical management 10 weeks after the initial management, but the blood loss was minimal. Discussion: A CSP may be asymptomatic or present with non-specific symptoms. The rate of initial misdiagnosis is as high as 76%. TVUSS enables correct CSP diagnosis and implementation of minimally invasive effective treatment. HCG levels can affect the overall outcome, but medical management can be considered even with high HCG levels. Conclusion: CSP is a life-threatening condition, therefore timely diagnosis and appropriate management is crucial. Medical management can be considered in most cases even with high HCG, but management has to be tailored according to the patient. Close follow up of patient after Medical treatment is important as they may require further intervention.

scholarly journals Cesarean Scar Ectopic Pregnancy: The Lurking Danger in Post Cesarean Failed Medical Abortion

2020 ◽  
Author(s):  
Monika Anant ◽  
Anita Paswan ◽  
Chandrajyoti Chandrajyoti
Keyword(s):  
Cesarean Section ◽  
Ectopic Pregnancy ◽  
Medical Abortion ◽  
Accurate Diagnosis ◽  
Tertiary Level ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Life Threatening ◽  
Missed Diagnosis ◽  
Level Hospital

Cesarean scar pregnancy (CSP) is a potentially life threatening ectopic pregnancy where a missed diagnosis is commoner than an accurate diagnosis. Incidence of Ectopic pregnancy is 1 – 2 % and cesarean scar ectopic occurs in about (0.05%) 1 in 2000 of all pregnancies. With increasing cesarean section rates worldwide, CSP is bound to increase with its dreaded complications like uterine rupture and catastrophic hemorrhage. Three patients misdiagnosed as incomplete miscarriages in post cesarean pregnancies in other centers were found to be CSP in Gynaecology department of a tertiary level hospital. All three patients were managed successfully, two surgically and one medically.  

scholarly journals Caesarean scar pregnancy: a case report with review of management options

2019 ◽  
Vol 8 (11) ◽  
pp. 4602
Author(s):  
Vandana Rani ◽  
Shaveta Jain ◽  
Vani Malhotra ◽  
Meenakshi B. Chauhan ◽  
Sarika Gautam ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Time Management ◽  
Management Options ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Future Fertility ◽  
Life Threatening ◽  
Hemodynamic Profile ◽  
Gestational Sac

Cesarean scar pregnancy is a rare but life-threatening complication. It is the abnormal implantation of gestational sac into myometrium and fibrous scar of previous cesarean section. Its incidence is on rising trend due to increase in rate of cesarean section all over the world. A thirty years old second gravida presented at eight weeks of gestation with complaints of bleeding per vaginum and pain lower abdomen. She was diagnosed as a case of cesarean scar pregnancy (CSP) on ultrasonography and confirmation of diagnosis was done on magnetic resonance imaging. Medical management of scar pregnancy was done successfully with combination of mifepristone and methotrexate. Cesarean scar pregnancy could be catastrophic, if not managed well in time. Management includes both surgical and medical options. Treatment has to be individualized depending on patient’s hemodynamic profile, size of gestational sac, desire for future fertility, compliance for follow up and availability of interventional radiology.

Emergent Hybrid Treatment of a Ruptured Scalp Arteriovenous Fistula with Eyelid involvement: Technical Note

2021 ◽  
Author(s):  
Juan Felipe Abaunza-Camacho ◽  
David Vergara-Garcia ◽  
Francisco Perez ◽  
Camilo Benavides ◽  
Alberto Caballero ◽  
...  
Keyword(s):  
Hypovolemic Shock ◽  
Endovascular Embolization ◽  
Technical Note ◽  
Medical Emergency ◽  
Severe Bleeding ◽  
Acute Anemia ◽  
Arteriovenous Fistulas ◽  
Life Threatening ◽  
Type C ◽  
Open Surgical Approach

Abstract Background Scalp arteriovenous fistulas (AVFs) are a rare vascular disease usually presenting as a progressively increasing pulsating mass in the scalp. These lesions can be associated with mild to severe complications, including congestive heart failure. If ruptures, this pathology constitutes a life-threatening medical emergency because of its potential to cause severe bleeding and acute anemia. Methods We describe the case of a young woman with a ruptured Yokouchi type C scalp AVF with eyelid involvement. Results The patient presented with hypovolemic shock and acute anemia due to severe bleeding from the lesion. Emergent treatment through a combined endovascular and open surgical approach was required to stop bleeding and stabilize the patient. Conclusions Emergent and effective treatment is required to stop bleeding when a scalp AVF ruptures. A combination of endovascular embolization and microsurgical excision of the shunt is a treatment option.

scholarly journals Cesarean Scar Ectopic Pregnancy: Treatment Decision Algorithm and Success With Medical Treatment

2021 ◽  
Author(s):  
Lorena Sabonet Lorente ◽  
Ana I. Guzman Leon ◽  
Pilar Espejo Reina ◽  
José Ramón Anderica Herrero ◽  
Ernesto Gonzalez Mesa ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Transvaginal Ultrasound ◽  
Treatment Options ◽  
Expectant Management ◽  
Treatment Decision ◽  
Maternal Condition ◽  
Decision Algorithm ◽  
Cesarean Scar ◽  
Future Fertility ◽  
Ectopic Pregnancies

Background Cesarean scar ectopic pregnancies are a rare form of extrauterine pregnancies, yet their incidence has increased along with the rise in the number of cesarean deliveries. As with other ectopic pregnancies, cesarean scar ectopic pregnancies pose a greater risk for maternal hemorrhage and ultimately maternal mortality. Case presentation We present a series of clinical cases of cesarean scar ectopic pregnancy diagnosed by transvaginal ultrasonography. Each patient received an individualized treatment: the rate of success depended on the particular maternal condition in each case. Due to the low frequency of this entity, there are no clear protocols for its treatment and thus there are numerous options for treatment and follow up: expectant management, medical therapy, surgical intervention, uterine artery embolization or a combined approach. Each method has different levels of success and is dependent on the surgeon’s skill and patient presentation. The transvaginal ultrasound is necessary to obtain the fine details of the gestation sac and its relation to the scar and must be followed by a meticulous abdominal scan with a full bladder. Conclusion Herein, we present a rare pathological phenomenon whose frequency is on the rise, and for which transvaginal ultrasound and flow doppler provide high diagnostic accuracy. Early diagnosis of cesarean scar ectopic pregnancies offers treatment options to that may help avoid uterine rupture and bleeding, thus preserving the uterus and future fertility.

scholarly journals Uterine inversion - an obstetrician’s nightmare: a series of 3 cases of uterine inversion and a review of management options

2021 ◽  
Vol 10 (5) ◽  
pp. 2050
Author(s):  
Rashmi G. Jalvee ◽  
Reena J. Wani
Keyword(s):  
Vaginal Delivery ◽  
Coming Out ◽  
Postpartum Haemorrhage ◽  
Treatment Options ◽  
Hypovolemic Shock ◽  
Blood Product Transfusion ◽  
Management Options ◽  
Uterine Inversion ◽  
First Case ◽  
Life Threatening

Acute puerperal uterine inversion is an extremely rare but potentially life-threatening complication in which the uterine fundus collapses within the endometrial cavity and beyond. Although the causes of uterine inversion are unclear, several predisposing factors have been described. Maternal mortality is extremely high unless the condition is recognized and corrected. We present here a series of three cases of uterine inversion managed in our hospital over a period of 3 years. Our first case, Mrs XYZ referred to our hospital after vaginal delivery followed by postpartum collapse. The patient was in hypovolemic shock with 2nd degree uterine inversion. Second case, Mrs ABC referred to our hospital after vaginal delivery and mass coming out of the vagina. The patient had postpartum haemorrhage with 2nd degree uterine inversion. Our third case, Mrs DEF, c/o full term vaginal delivery at our hospital with 2nd degree uterine inversion with postpartum haemorrhage. In all three cases, the patients were explored in the OT under general anaesthesia and uterine reposition was done vaginally. Two of the patients required mechanical ventilation post operatively and all the patients required blood and blood product transfusion. The clinical management, treatment options and surgical nuances of management of uterine inversion are discussed.

scholarly journals Cesarean Scar Ectopic Pregnancy—Case Series: Treatment Decision Algorithm and Success with Medical Treatment

Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 362
Author(s):  
Lorena Sabonet Morente ◽  
Ana I. Guzmán León ◽  
M. Pilar Espejo Reina ◽  
Jose R. Anderica Herrero ◽  
Ernesto González Mesa ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Transvaginal Ultrasound ◽  
Treatment Options ◽  
Case Series ◽  
Expectant Management ◽  
Maternal Condition ◽  
Decision Algorithm ◽  
Cesarean Scar ◽  
Future Fertility ◽  
Ectopic Pregnancies

Background: Cesarean scar ectopic pregnancies are a rare form of extrauterine pregnancies, yet their incidence has increased along with the rise in the number of cesarean deliveries. As with other ectopic pregnancies, cesarean scar ectopic pregnancies pose a greater risk for maternal hemorrhage and ultimately maternal mortality. Case presentation: We present a series of clinical cases of cesarean scar ectopic pregnancy diagnosed by transvaginal ultrasonography. Each patient received an individualized treatment: the rate of success depended on the particular maternal condition in each case. Due to the low frequency of this entity, there are no clear protocols for its treatment and thus there are numerous options for treatment and follow-up: expectant management, medical therapy, surgical intervention, uterine artery embolization or a combined approach. Each method has different levels of success and is dependent on the surgeon’s skill and patient presentation. A transvaginal ultrasound is necessary to obtain the fine details of the gestation sac and its relation to the scar and must be followed by a meticulous abdominal scan with a full bladder. Conclusion: Herein, we present a rare pathological phenomenon whose frequency is on the rise, and for which transvaginal ultrasound and flow Doppler provide high diagnostic accuracy. Early diagnosis of cesarean scar ectopic pregnancies offers treatment options that may help avoid uterine rupture and bleeding, thus preserving the uterus and future fertility.

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