Early detection of a cesarean scar pregnancy with placenta increta by contrast‐enhanced ultrasound in the first trimester: A case report and literature review

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.

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Contrast-Enhanced Ultrasound Evaluation of Mifepristone for Treatment of Low-Risk Cesarean Scar Pregnancy

Contrast Media & Molecular Imaging ◽

10.1155/2020/3725353 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Xi Xiong ◽

Chun-yan Gao ◽

De-mei Ying ◽

Ping Yan ◽

Zhi-jia Zhang ◽

...

Keyword(s):

Effective Treatment ◽

Low Risk ◽

Contrast Enhanced Ultrasound ◽

Intrauterine Pregnancy ◽

Cesarean Scar Pregnancy ◽

Cesarean Scar ◽

Ultrasound Evaluation ◽

Contrast Enhanced ◽

Significant Difference ◽

Before And After

Purpose. The effect of mifepristone for treatment of low-risk cesarean scar pregnancy (CSP) was monitored by contrast-enhanced ultrasound (CEUS). Methods. Data were collected from 23 CSP patients with a 10-point risk score <5 (low-risk CSP) and from 23 intrauterine pregnancy (IUP) patients with a scar from a previous cesarean delivery. All patients were prescribed 75 mg mifepristone daily for 2 days and underwent transvaginal CEUS before and after administration of mifepristone. On the third day, uterine curettage was performed after transvaginal CEUS. Arrival time (AT), peak intensity (PI), and area under the curve (AUC) around the gestational sac were monitored by CEUS before and after application of mifepristone, and the rate of effective treatment was compared between the two patient groups. Results. No patients experienced side effects from either the CEUS procedure or the mifepristone treatment. Changes in AT, PI, and AUC index from before vs. after mifepristone treatment did not differ significantly between the two groups (all p values >0.05). There was also no significant difference in the rate of effective treatment between the two groups (95.65% in the CSP group vs. 100% in the IUP group; p > 0.05 ). Conclusions. Based on monitoring by CEUS, the effect of mifepristone in low-risk CSP was comparable to that in IUP.

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Giant broad ligament leiomyoma with postoperative infection diagnosed with contrast‐enhanced ultrasound: Case report and literature review

Journal of Clinical Ultrasound ◽

10.1002/jcu.23081 ◽

2021 ◽

Author(s):

Li Guo ◽

Mi Zhou Wang ◽

Li Jing Wang ◽

Ai Hua Zang ◽

Dong Mei Jia ◽

...

Keyword(s):

Case Report ◽

Literature Review ◽

Postoperative Infection ◽

Broad Ligament ◽

Contrast Enhanced Ultrasound ◽

Contrast Enhanced

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The Value of Contrast-Enhanced Ultrasound in the Diagnosis of Cesarean Scar Pregnancy

BioMed Research International ◽

10.1155/2016/4762785 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 9

Author(s):

Xi Xiong ◽

Ping Yan ◽

Chunyan Gao ◽

Qiulei Sun ◽

Fenglian Xu

Keyword(s):

Predictive Value ◽

Lower Uterine Segment ◽

Youden Index ◽

Peak Time ◽

Contrast Enhanced Ultrasound ◽

Cesarean Scar Pregnancy ◽

Cesarean Scar ◽

Contrast Enhanced ◽

Significant Difference ◽

Conventional Ultrasound

Objective. To evaluate the value of contrast-enhanced ultrasound (CEUS) in the cesarean scar pregnancy (CSP).Methods. Clinical data from 92 patients with lower uterine segment pregnancy, who underwent conventional ultrasound and CEUS examination in the Department of Obstetrics and Gynecology, were collected by Xinqiao Hospital Third Military Medical University from March 2014 to March 2015. The parameters of ultrasound contrast time-intensity curve (TIC), including arrival time, time to peak, time from peak to one half, basic intensity, peak intensity, and wash-in slope, were analyzed.Results. Of the 92 cases of patients with pregnancy in the lower uterine segment, 52 cases were CSP, and 40 cases were intrauterine pregnancy. CEUS was significantly better than conventional ultrasound in terms of sensitivity, negative predictive value, Youden index, and diagnostic accuracy (P<0.05). There was no significant difference in specificity and positive predictive value (P>0.05).Conclusion. CEUS has a higher accuracy than conventional ultrasound in diagnosis of CSP.

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Efficacy of contrast-enhanced ultrasound for diagnosis of cesarean scar pregnancy type

Medicine ◽

10.1097/md.0000000000017741 ◽

2019 ◽

Vol 98 (44) ◽

pp. e17741 ◽

Cited By ~ 3

Author(s):

Yun Wu ◽

Liuying Zhou ◽

Lin Chen ◽

Qian Zhou ◽

Tao Zeng

Keyword(s):

Contrast Enhanced Ultrasound ◽

Cesarean Scar Pregnancy ◽

Cesarean Scar ◽

Contrast Enhanced

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Contrast-enhanced ultrasound in uterine artery embolization treatment of cesarean scar pregnancy

Journal of International Medical Research ◽

10.1177/0300060520980217 ◽

2020 ◽

Vol 48 (12) ◽

pp. 030006052098021

Author(s):

Dongmei Liu ◽

Xiaoning Gu ◽

Fang Liu ◽

Fuwen Shi ◽

Min Yang

Keyword(s):

Uterine Artery Embolization ◽

Uterine Artery ◽

Transvaginal Ultrasound ◽

Contrast Enhanced Ultrasound ◽

Artery Embolization ◽

Time Intensity Curve ◽

Cesarean Scar Pregnancy ◽

Cesarean Scar ◽

Contrast Enhanced ◽

Myometrial Thickness

Objective The current study aimed to investigate the application of contrast-enhanced ultrasound (CEUS) in diagnosis and treatment of cesarean scar pregnancy (CSP). Methods A retrospective study was performed in 35 patients with clinically suspected CSP who requested termination of pregnancy and underwent contrast-enhanced ultrasound (CEUS). The patients were classified into two groups on the basis of whether they received uterine artery embolization (UAE). The CEUS characteristics of the two groups were reviewed. Results CEUS features of CSP were early enhancement of the cesarean scar and continuous infusion of contrast agent between the gestational sac and cesarean scar. Myometrial thickness in the cesarean scar was thinner in the UAE group than in the non-UAE group by CEUS and transvaginal ultrasound. Myometrial thickness measured by CEUS was thinner than that measured by transvaginal ultrasound in both groups. The parameters of the time-intensity curve in the UAE group were characterized by a faster arrival time, shorter time to peak, higher peak intensity, and greater enhancement rate compared with the non-UAE group. Conclusions CEUS may be a novel supplementary method to diagnose and assess CSP, and to help evaluate whether UAE is required.

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