scholarly journals Resection of Cesarean Scar Pregnancy at Six Weeks of Gestation with Laminaria Cervical Dilatation under Sonographic and Hysteroscopic Guidance

2015 ◽  
Vol 2015 ◽  
pp. 1-6
Author(s):  
Tatsuji Hoshino ◽  
Taito Miyamoto ◽  
Shinya Yoshioka
Keyword(s):  
Transvaginal Ultrasound ◽  
Clinical History ◽  
Anterior Wall ◽  
Cervical Dilatation ◽  
Cesarean Scar Pregnancy ◽  
Chorionic Villi ◽  
Cesarean Scar ◽  
Decidua Basalis ◽  
Gestational Sac ◽  
Almost All

In cases of fetal heartbeat- (FHB-) positive cesarean scar pregnancy (CSP), the embryo and placenta grow rapidly week by week. We experienced an FHB-positive CSP case at 6 weeks of gestation and assessed the CSP in detail with transvaginal ultrasound and transabdominal ultrasound (TAUS), preoperatively. We performed Laminaria cervical dilatation under TAUS guidance and performed hysteroscopic resection of the pregnancy conceptus and curettage under hysteroscopic and TAUS guidance. We identified the gestational sac attached to the cesarean scar pouch with small plane, decidua basalis, and chorionic villi and present the clinical history and other findings. We also reviewed the related literature and found 76 previous studies, with six cases of FHB-positive CSP that contained hysteroscopic color images of the CSP. We present a review of selected cases. The implantation site was the anterior wall in almost all cases. Cervical dilatation was mainly performed using a Hegar dilator; ours was the only case using Laminaria dilatation. Transcervical resections were performed mainly under ultrasound guidance, with only one case undergoing laparoscopy. Electrocoagulation was performed in three of the six cases.

scholarly journals Risk factors for poor hemostasis of prophylactic uterine artery embolization before curettage in cesarean scar pregnancy

2020 ◽  
Vol 48 (10) ◽  
pp. 030006052096437
Author(s):  
Hongan Tian ◽  
Shunzhen Li ◽  
Wanwan Jia ◽  
Kaihu Yu ◽  
Guangyao Wu
Keyword(s):  
Risk Factors ◽  
Blood Supply ◽  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Embolic Agent ◽  
Artery Embolization ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Hemorrhage Volume ◽  
Gestational Sac

Objective To observe the hemostatic effect of prophylactic uterine artery embolization (UAE) in patients with cesarean scar pregnancy (CSP) and to examine the risk factors for poor hemostasis. Methods Clinical data of 841 patients with CSP who underwent prophylactic UAE and curettage were retrospectively analyzed to evaluate the hemorrhage volume during curettage. A hemorrhage volume ≥200 mL was termed as poor hemostasis. The risk factors of poor hemostasis were analyzed and complications within 60 days postoperation were recorded. Results Among the 841 patients, 6.30% (53/841) had poor postoperative hemostasis. The independent risk factors of poor hemostasis were gestational sac size, parity, embolic agent diameter (>1000 μm), multivessel blood supply, and incomplete embolization. The main postoperative complications within 60 days after UAE were abdominal pain, low fever, nausea and vomiting, and buttock pain, with incidence rates of 71.22% (599/841), 47.44% (399/841), 39.12% (329/841), and 36.39% (306/841), respectively. Conclusions Prophylactic UAE before curettage in patients with CSP is safe and effective in reducing intraoperative hemorrhage. Gestational sac size, parity, embolic agent diameter, multivessel blood supply, and incomplete embolization of all arteries supplying blood to the uterus are risk factors of poor hemostasis.

Local intra-gestational sac methotrexate injection followed by dilation and curettage in treating cesarean scar pregnancy

2020 ◽  
Vol 302 (2) ◽  
pp. 439-445 ◽  
Author(s):  
Kai-Liang Tan ◽  
Li Jiang ◽  
Yu-Mei Chen ◽  
Ying Meng ◽  
Bang-Quan Lv ◽  
...  
Keyword(s):  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Dilation And Curettage ◽  
Gestational Sac

scholarly journals Placenta Increta Complicating Persistent Cesarean Scar Ectopic Pregnancy following Failed Excision with Subsequent Preterm Cesarean Hysterectomy

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
M. F. Malik ◽  
L. R. Hoyos ◽  
J. Rodriguez-Kovacs ◽  
J. Gillum ◽  
S. C. Johnson
Keyword(s):  
Ectopic Pregnancy ◽  
Placenta Increta ◽  
Pelvic Mri ◽  
Chorionic Villi ◽  
Thin Endometrium ◽  
Cesarean Scar ◽  
Cesarean Hysterectomy ◽  
Cesarean Deliveries ◽  
History Of ◽  
Gestational Sac

Introduction.Cesarean scar pregnancies (CSPs) are one of the rarest forms of ectopic pregnancy. Given their rarity, there is lack of consensus regarding the management and natural course of CSPs.Case.A 37-year-old G10 P3063 female with a history of two prior cesarean deliveries was diagnosed with her second CSP at 6 weeks and 5 days in her tenth pregnancy. The patient underwent vertical hysterotomy, excision of a gestational sac implanted in the cesarean sac, and bilateral salpingectomy via a laparotomy incision. The histopathology report confirmed immature chorionic villi. The patient returned 10 weeks later and was found to be still pregnant. Obstetric ultrasound confirmed a viable fetus of 19 weeks and 4 days of gestational age with a thin endometrium and an anteroposterior and right lateral placenta with multiple placental lakes. The patient ruptured her membranes at 31 weeks of gestation and pelvic MRI revealed an anterior placenta invading the myometrium and extending to the external serosal surface consistent with placenta increta. Following obstetric interventions, a live female infant was delivered by cesarean hysterectomy (because of placenta increta) at 32 weeks of gestation.Conclusion.Development of standardized guidelines for management of CSPs, as well as heightened vigilance for possible complications, is required for proper care and avoidance of potential morbidity and mortality.

scholarly journals Uterine artery pseudoaneurysm after treatment of cesarean scar pregnancy: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jiao Wang ◽  
Qing Yang ◽  
Ningning Zhang ◽  
Dandan Wang
Keyword(s):  
Vaginal Bleeding ◽  
Uterine Artery ◽  
Rare Complication ◽  
Transvaginal Ultrasound ◽  
Massive Hemorrhage ◽  
Cesarean Scar Pregnancy ◽  
Artery Pseudoaneurysm ◽  
Cesarean Scar ◽  
Effective Diagnosis ◽  
Uterine Artery Pseudoaneurysm

Abstract Background Pseudoaneurysms are formed when a local arterial wall ruptures, leading to hemorrhage and hematoma adjacent to the artery. Continuous perfusion of the injured artery increases the pressure in the lumen of the pseudoaneurysm. It may rupture and lead to massive hemorrhage that could be life-threatening. Cesarean scar pregnancy (CSP) is an ectopic pregnancy where the gestational sac is implanted in the cesarean scar. Uterine artery pseudoaneurysm (UAP) after CSP treatment is rare. Case presentation We report the case of a 36-year-old Chinese woman who presented with acute massive vaginal bleeding 53 days after transabdominal scar pregnancy excision. Doppler ultrasound confirmed UAP. Selective uterine artery embolization (UAE) failed because of the thin and curved blood vessels. The lesion decreased in size after transvaginal ultrasound-guided direct thrombin injection (UGTI); however, massive vaginal bleeding recurred and endangered the patient’s life. The uterus was removed thereafter. Conclusions UAP is a rare complication after CSP treatment that can lead to fatal massive hemorrhage. Ultrasound should be reexamined regularly after treatment of CSP. In case of unexplained vaginal bleeding, we should be alert to the existence of UAP and the possibility of rupture and take effective diagnosis and treatment measures promptly.

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

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.

scholarly journals Differential Diagnosis of Cesarean Scar Pregnancies and Other Pregnancies Implanted in the Lower Uterus by Ultrasound Parameters

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Kangning Li ◽  
Qing Dai
Keyword(s):  
Differential Diagnosis ◽  
Cesarean Section ◽  
Transvaginal Ultrasound ◽  
Previous Cesarean Section ◽  
Cesarean Scar Pregnancy ◽  
Rare Type ◽  
Cesarean Section Delivery ◽  
Cesarean Scar ◽  
The Relationship ◽  
Previous Cesarean

Purpose. Cesarean scar pregnancy is an extremely rare type of ectopic pregnancy implanted in the myometrium at the site of a previous cesarean section scar. On the other hand, pregnancies are considered low implantations if they are identified in the lower third of the uterus without the sac implanted into the scar and have a better prognosis. Early diagnosis of both types of pregnancies can help avoid serious complications. This study is aimed at investigating the significance of transvaginal ultrasound in the differential diagnosis of cesarean scar pregnancies and pregnancies implanted in the lower uterus. Methods. Ninety-three patients with an average age of 32.7 years (range, 24–43 years) were enrolled in this study, including 66 cesarean scar pregnancies and 27 other pregnancies implanted in the lower uterus, and they were examined by transvaginal ultrasound. Results. We observed significant differences in the relationship between the cesarean sac and the scar, the source of the trophoblastic blood flow, and the thickness of the residual muscle between the cesarean scar pregnancy group and the lower uterus pregnancy group. We established the logistic model to improve the differential diagnosis of cesarean scar pregnancies and pregnancies implanted in the lower uterus. Conclusions. Transvaginal ultrasound is recommended in early pregnancy, especially for patients who have undergone a previous cesarean section delivery.

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