scholarly journals Cesarean scar pregnancy: clinicians challenge

2017 ◽  
Vol 6 (5) ◽  
pp. 2101
Author(s):  
Priyanka Harshavardhan Vora ◽  
Vandana Bansal
Keyword(s):  
Ectopic Pregnancy ◽  
Transvaginal Ultrasound ◽  
Uterine Cavity ◽  
Cesarean Scar Pregnancy ◽  
Sequential Approach ◽  
Cesarean Scar ◽  
Caesarean Scar

A case of caesarean scar ectopic pregnancy managed diagnosed early on transvaginal ultrasound and managed successfully by sequential approach of methotrexate and hysteroscopic removal preserving the woman’s fertility is discussed below. Ectopic pregnancy i.e. implantation of the blastocyst outside the endometrium of the uterine cavity occurs in 1.9% of reported pregnancies.

scholarly journals Recurrent Cesarean Scar Ectopic Pregnancy Treated with Systemic Methotrexate

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Chima Ndubizu ◽  
Rodney A. McLaren ◽  
Sandra McCalla ◽  
Mohamad Irani
Keyword(s):  
Ectopic Pregnancy ◽  
Complete Resolution ◽  
Transvaginal Ultrasound ◽  
Rare Event ◽  
Artery Embolization ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Cesarean Deliveries ◽  
Beta Human Chorionic Gonadotropin ◽  
History Of

Cesarean scar pregnancy (CSP) is a rare event; however its incidence has been rising due to the increasing rates of cesarean deliveries. The majority of cases present with signs or symptoms requiring surgery, which often results in hysterectomy. The recurrence of CSP is even rarer with only few cases which have been reported. This is a report of recurrent cesarean scar ectopic pregnancy (RCSP) that was promptly diagnosed and managed with only systemic methotrexate. This was a 30-year-old woman, with a history of two prior cesarean deliveries followed by a CSP, who presented at 5 weeks and 3 days of gestation for her first prenatal visit. Transvaginal ultrasound revealed a RCSP. Her serum beta-human chorionic gonadotropin (β-hCG) level was 54,295 IU/L. The first CSP, which was diagnosed at a later stage, was treated with uterine artery embolization and systemic methotrexate leading to complete resolution within 10 weeks. The current ectopic was treated with two doses of systemic methotrexate; her serum β-hCG reached undetectable levels within 7 weeks. Thus, patients with a history of prior CSP should be carefully monitored with transvaginal ultrasound during subsequent pregnancies to allow early diagnosis of RCSP, which could then be treated conservatively.

Hysteroscopic Intact Removal of Angular and Caesarean Scar Pregnancy: A Novel and Markedly Less Invasive Surgical Treatment

2020 ◽  
pp. 1-8
Author(s):  
Antonio Mollo ◽  
Alessandra Battagliese ◽  
Massimo Mascolo ◽  
Antonio Raffone ◽  
Antonio Travaglino ◽  
...  
Keyword(s):  
Treatment Success ◽  
Complication Rates ◽  
Cesarean Scar Pregnancy ◽  
Invasive Approach ◽  
Less Invasive ◽  
Cesarean Scar ◽  
Caesarean Scar ◽  
Novel Technique ◽  
Video Archives ◽  
Removal Technique

<b><i>Introduction:</i></b> Ectopic pregnancy is the most common cause of mortality during the first trimester of pregnancy, and intrauterine ectopic pregnancies show significantly higher morbidity and mortality than extrauterine ones. Despite being less invasive, safety and effectiveness of the hysteroscopic treatment are still unclear. Moreover, such approach is not standardized. We aimed to evaluate safety and effectiveness of hysteroscopic intact removal of angular or cesarean section scar pregnancies, defining a novel and markedly less invasive hysteroscopic technique with a 5-mm Bettocchi hysteroscope or a 3.5-mm Versascope hysteroscope. <b><i>Materials and Methods:</i></b> Medical records and video archives were reviewed for all the patients with angular or caesarean scar pregnancies treated with hysteroscopic intact removal technique from January 2000 to December 2018 at our Department. Success and complication rates were assessed. <b><i>Results:</i></b> Four patients with angular (<i>n</i> = 1) or cesarean scar pregnancy (<i>n</i> = 3) met inclusion criteria. Case #1 was treated with bipolar resectoscope, cases #2 and #3 with 5-mm Bettocchi hysteroscope, and case #4 with 3.5-mm Versascope hysteroscope. Cases #2–4 did not require cervical dilatation. Before hysteroscopic treatment, cases #2–4 underwent unsuccessful medical therapy with multiple-dose methotrexate. Hysteroscopic treatment success rate was 100%, while complication rate was 0%. All patients were treated with a novel technique: hysteroscopic intact removal of angular or cesarean scar pregnancies. Such technique was described step-by-step. <b><i>Conclusions:</i></b> Hysteroscopic treatment of angular and cesarean scar pregnancies may be a safe and effective minimally invasive option. The novel technique of hysteroscopic intact removal technique may allow a markedly less invasive approach.

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 Cesarean Scar Ectopic Pregnancy: Case Report and Review of the Literature

2016 ◽  
Vol 8 (1) ◽  
pp. 66-68
Author(s):  
Thankam Varma ◽  
Shashidhar Boraiah
Keyword(s):  
Case Report ◽  
Ectopic Pregnancy ◽  
Tertiary Care ◽  
Review Of The Literature ◽  
Artery Embolization ◽  
Cesarean Scar Pregnancy ◽  
Rare Type ◽  
Cesarean Scar ◽  
Maternal Morbidity And Mortality ◽  
Tertiary Care Hospitals

ABSTRACT Cesarean scar ectopic pregnancy is becoming increasingly common in tertiary care hospitals. Cesarean scar pregnancy is a rare type of ectopic pregnancy associated with complications, such as uterine rupture, uncontrollable bleeding which may lead to hysterectomy and increased maternal morbidity and mortality and subsequent infertility. Options available for treatment, such as dilatation and curettage, excision of trophoblastic tissues using laparotomy or laparoscopy, systemically administered methotrexate, and more recently uterine artery embolization. We report two such cases between 2012 and 2013 managed conservatively. How to cite this article Boraiah S, Varma T, Shankar K. Cesarean Scar Ectopic Pregnancy: Case Report and Review of the Literature. J South Asian Feder Obst Gynae 2016;8(1):66-68.

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 Cornual Heterotopic Pregnancy after Bilateral Salpingectomy and Uterine Septum Resection Resulting in Term Delivery of a Healthy Infant

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Serkan Oral ◽  
Yaşam Kemal Akpak ◽  
Nilay Karaca ◽  
Ali Babacan ◽  
Kadir Savan
Keyword(s):  
Ectopic Pregnancy ◽  
Transvaginal Ultrasound ◽  
Uterine Cavity ◽  
Heterotopic Pregnancy ◽  
Simultaneous Occurrence ◽  
Free Fluid ◽  
Uterine Septum ◽  
Bilateral Salpingectomy ◽  
Live Fetus

Heterotopic pregnancy is the simultaneous occurrence of two or more implantation sites. A 25-year-old infertile patient with a history of bilateral salpingectomy, uterine septum resection, and left cornual resection was diagnosed with heterotopic pregnancy in her secondin vitrofertilization trial. She attended our clinic when she was 7-week pregnant, complaining initially of severe abdominal pain. Findings associated with peritoneal irritation were positive during the physical examination. Transvaginal ultrasound revealed right cornual ectopic pregnancy with a live fetus in the middle of the uterine cavity. Also free fluid was noted in the pelvis. A diagnosis of heterotopic pregnancy with rupture of the cornual pregnancy was made. She underwent emergency laparoscopy with aspiration of the ruptured ectopic pregnancy, suturing to the entire visible cornual margins, and assurance of good haemostasis. Her recovery was uneventful and she continued receiving care in our obstetric unit. She delivered a healthy newborn by cesarean section at term.

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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