scholarly journals Study of various treatment modalities of caesarean scar pregnancy

2021 ◽  
Vol 11 (1) ◽  
pp. 217
Author(s):  
Prachi C. Meghani ◽  
Sapna R. Shah ◽  
Rupa C. Vyas ◽  
Purvi M. Parikh ◽  
Tanmay J. Chudasama
Keyword(s):  
Gestational Age ◽  
Color Doppler ◽  
Haemorrhagic Shock ◽  
Treatment Modalities ◽  
Transvaginal Sonography ◽  
Caesarean Scar ◽  
Global Rate ◽  
Ultrasound Findings ◽  
Caesarean Scar Pregnancy ◽  
Β Hcg

Background: Caesarean scar pregnancy (CSP) can be defined as the implantation of the gestational sac within the scar of a previous caesarean surgery. Incidence of CSP is 1 in 1800 pregnancies.Methods: It is a retrospective study based on clinical diagnosis and management of CSP of women who presented to the obstetrics and gynaecology department SVP hospital from January 2008 to August 2021. Total number of cases of CSP were 28. Incidence, gestational age, ultrasound findings, serum β-human chorionic gonadotropin (β-hCG) levels, flow profiles of color Doppler, and different methods of treatment were recorded. Diagnosis was confirmed by ultrasound.Results: In this study, all 28 cases of CSP considered were offered definitive management. In present study 5 cases (17.88%) showed torrential haemorrhage during dilatation and evacuation (D and E) which was treated by various methods like 1 (3.57%) Foley’s tamponade, 1 (3.57%) uterine artery embolization (UAE) and 3 (10.71%) hysterectomy. Hysterotomy was performed in 13 cases (46.42%) and (7.69%) of heterotrophic CSP (HCSP). One case (3.84%) of CSP presented at 26 weeks of gestation with haemorrhagic shock, underwent obstetric hysterectomy.Conclusions: There is a rise in the incidence of CSP because of increase in the global rate of caesarean sections and early transvaginal USG in pregnancy. Transvaginal sonography is the best diagnostic tool. Medical management can be offered when diagnosis is made at gestational age of <7 weeks. Whereas, surgical modalities have shown better results at >7 weeks of gestational age. Surgical management has an advantage of shorter follow up. 

scholarly journals Caesarean Scar Pregnancy: A Case Series

2019 ◽  
Vol 37 (4) ◽  
pp. 191-195
Author(s):  
Liza Chowdhury ◽  
Anjana ◽  
Ishrat Jahan
Keyword(s):  
Gestational Age ◽  
Vaginal Bleeding ◽  
Caesarean Section Rate ◽  
Balloon Catheter ◽  
Case Series ◽  
Variable Degree ◽  
Lower Abdomen ◽  
Excessive Bleeding ◽  
Caesarean Scar ◽  
Caesarean Scar Pregnancy

Caesarean section rate is increasing day by day. Incidence of caesarean scar pregnancy (CSP) is also increasing. Prompt and multidisciplinary approach towards diagnosis of the condition is required to reduce associated morbidity. Major haemorrhage and hysterectomy are the main risks associated with CSP. Therefore, adequate counseling and availability of surgical expertise and blood transfusion should be part of a comprehensive management strategy. There are many single reports in literature but only few case series. In this paper, 10 cases of caesarean scar pregnancy treated in Obstetrics and Gynaecology department of CMH Dhaka, CMH Jashore and Hightech Multicare Hospital Private Limited over 10 years are analyzed. Three of 10 patients had mild pain in their lower abdomen and vaginal bleeding. Seven of them had profuse bleeding during D&C for miscarriage as they were not diagnosed at the time of admission. All patients had 1 or 2 caesarean sections. Gestational age of the pregnancy was estimated from 8 to 12 weeks by the last menstrual period. 9 patients were treated surgically. Eight of them had local resection of ectopic pregnancy mass with conservation of the uterus. One patient was treated with D&C followed by intrauterine balloon catheter insertion to control excessive bleeding. There was no total or subtotal hysterectomy. One patient was treated with Inj. Methotrexate. Common symptoms of caesarean scar pregnancy are pain in the lower abdomen and variable degree of vaginal bleeding. The treatment depends on severity of symptoms, gestational age and experience of the obstetrician dealing these cases. J Bangladesh Coll Phys Surg 2019; 37(4): 191-195

scholarly journals Partial Molar Caesarean Scar Pregnancy- A Case Report

2021 ◽  
Author(s):  
Usha Justa ◽  
Geetika Gupta Syal ◽  
Rita Mittal ◽  
Shruti Jha ◽  
Jyotika Bala
Keyword(s):  
Case Report ◽  
Wedge Resection ◽  
Caesarean Section Rate ◽  
Rare Condition ◽  
Gestational Trophoblastic Disease ◽  
Treatment Modalities ◽  
Caesarean Scar ◽  
Severe Haemorrhage ◽  
Future Fertility ◽  
Caesarean Scar Pregnancy

Caesarean Scar Pregnancy (CSP) is a rare entity. Gestational Trophoblastic Disease (GTD) in a CSP is exceedingly rare. This can lead to complications like rupture uterus, severe haemorrhage, hypovolemia which may require hysterectomy, endanger a woman’s life, her future fertility and death. As no therapeutic protocols have been established about this rare condition, it is difficult to diagnose and manage. The case report describes a patient, 26-year-old gravida 2 para 1, was diagnosed with a CSP with partial mole. She was treated with systemic Methotrexate (MTX) followed by surgery-wedge resection of ectopic mass and repair of uterus. Patient remained on β-hCG follow-up with us. The management of CSP requires high clinical suspicion and immediate action with combination of various treatment modalities. Primary caesarean section rate must be reduced by performing caesareans only for justified reasons, so as to decrease the incidence of scar pregnancies.

scholarly journals Evaluation of treatment of previous cesarean scar pregnancy with methotrexate: a systematic review and meta-analysis

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Nader Salari ◽  
Mohsen Kazeminia ◽  
Shamarina Shohaimi ◽  
Anis al-Dawlah Nankali ◽  
Masoud Mohammadi
Keyword(s):  
Ectopic Pregnancy ◽  
Meta Analysis ◽  
Fibrous Tissue ◽  
Cesarean Scar Pregnancy ◽  
Caesarean Scar ◽  
Caesarean Scar Pregnancy ◽  
The Mean ◽  
Β Hcg ◽  
Mean Time ◽  
Previous Cesarean

Abstract Background Previous caesarean scar pregnancy is one type of ectopic pregnancy in myometrium and fibrous tissue of previous caesarean scar. One of the therapeutic methods of this type of ectopic pregnancy is treatment with methotrexate. Given various findings on the treatment of caesarean scar pregnancy with methotrexate and lack of global report in this regard, we aimed to achieve a global report on the treatment of CSP with methotrexate through related literature review and analysis of the results of the studies, to enable more precise planning to reduce complications of CSP. Method This review study extracted information through searching national and international databases of SID،, Embase, ScienceDirect, ، Scopus, ، PubMed, Web of Science (ISI) between 2003 and January 2020. To perform the meta-analysis, random-effects model and heterogeneity of the studies with I2 index were investigated. Data were sanalysed using Comprehensive Meta-Analysis version 2. Results In total, 26 articles with a sample size of 600 individuals were enrolled in the meta-analysis. According to the results of the study, the mean level of β-hCG was 28,744.98 ± 4425.1 mIU/ml before the intervention and was 23,836.78 ± 4533.1 mIU/ml after the intervention. The mean intraoperative blood loss (ml) was 4.8 ± 3.76 ml, mean hospital stay (days) was 11.7 ± 1.2 days, mean time for serum-hCG normalization (days) was 41.6 ± 3.2 days, success was 90.7% (95% CI: 86.7–93.5%), and complication was 9% (95% CI: 6.3–12.8%). Conclusion The results of the current study show methotrexate significantly reduces β-hCG levels and can be effective in treating caesarean scar pregnancy and its complications.

scholarly journals EP23.22: Case report: conservative surgical management of Caesarean scar pregnancy at 14 weeks of gestational age

2019 ◽  
Vol 54 (S1) ◽  
pp. 390-390
Author(s):  
S. Elsirgany ◽  
A.Z. Elsheikhah ◽  
A. Rammah ◽  
A. Osama ◽  
A. Khalil
Keyword(s):  
Case Report ◽  
Surgical Management ◽  
Gestational Age ◽  
Caesarean Scar ◽  
Caesarean Scar Pregnancy

scholarly journals Laparoscopy or Laparotomy for High-risk Caesarean Scar Pregnancy: A Retrospective Study

2021 ◽  
Author(s):  
Ting Zhou ◽  
Shixuan Wang ◽  
Peiying Fu ◽  
Pengfei Cui ◽  
Ronghua Liu
Keyword(s):  
Laparoscopic Surgery ◽  
High Risk ◽  
Arterial Occlusion ◽  
Vascular Occlusion ◽  
Transfusion Rate ◽  
Advantages And Disadvantages ◽  
Caesarean Scar ◽  
Caesarean Scar Pregnancy ◽  
Treatment Measures ◽  
Β Hcg

Abstract Background: Caesarean scar pregnancy (CSP) can have catastrophic consequences. A standardized diagnosis and treatment for CSP are still lacking. The currently available treatment methods are confusing, and at least 10 different treatment measures exist. The aim of this study was to compare the outcomes of with laparotomy or laparoscopy in the treatment of high-risk CSP. Methods: We reviewed 935 patients with CSP from 1 January 2013 and 31 December 2018. A total of 278 patients were included in the study, of whom 121 were treated with laparoscopy and 157 were treated with laparotomy.Results: We compared and analysed the characteristics of the laparoscopic and open surgeries in the treatment of high-risk CSP and the advantages and disadvantages of different methods of vascular pretreatment. Intraoperative bleeding, transfusion rate, total days of hospitalization and postoperative hospital stay were better in laparoscopy than in laparotomy (P < 0.05). There was no difference in the factors (β-HCG decrease, reoperation and tissue residues) closely related to the success of the surgery in the two groups. Furthermore, we pretreated blood vessels differently before the operation in some patients. Tissue residue, reoperation and intraoperative blood transfusion rates in patients with temporary vascular occlusion were better than in patients with permanent vascular occlusion. Conclusions: This study revealed that laparoscopic surgery is superior to laparotomic surgery in the treatment of high-risk CSP. Patients benefited from temporary arterial occlusion in both groups. Temporary arterial occlusion under laparoscopic surgery may be the best treatment for high-risk CSP.

scholarly journals Ruptured Ectopic Pregnancy in Caesarean Section Scar: A Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Kamal Singh ◽  
Anjali Soni ◽  
Shelly Rana
Keyword(s):  
Case Report ◽  
Caesarean Section ◽  
Ectopic Pregnancy ◽  
Maternal Morbidity ◽  
Rare Case ◽  
First Trimester ◽  
Transvaginal Sonography ◽  
Caesarean Scar ◽  
Future Fertility ◽  
Caesarean Scar Pregnancy

Pregnancy implantation within previous caesarean scar is one of the rarest locations for an ectopic pregnancy. Incidence of caesarean section is increasing worldwide and with more liberal use of transvaginal sonography, more cases of caesarean scar pregnancy are being diagnosed in early pregnancy thus allowing preservation of uterus and fertility. However, a delay in either diagnosis or treatment can lead to uterine rupture, hysterectomy, and significant maternal morbidity. We are reporting a rare case of first trimester caesarean scar pregnancy with viable fetus in the process of rupture, where uterine repair could be done, thus preserving the future fertility.

Treatment of asymptomatic uterine rupture of caesarean scar pregnancy in patient with advanced gestational age: case report

2017 ◽  
Vol 38 (4) ◽  
pp. 571-572 ◽  
Author(s):  
Pierluigi Giampaolino ◽  
Luigi Della Corte ◽  
Piero Venetucci ◽  
Felice D’Antuono ◽  
Ilaria Morra ◽  
...  
Keyword(s):  
Case Report ◽  
Gestational Age ◽  
Uterine Rupture ◽  
Caesarean Scar ◽  
Caesarean Scar Pregnancy

scholarly journals Combination of medical and surgical management in successful treatment of caesarean scar pregnancy: a case report series

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Anda Pristavu ◽  
Angela Vinturache ◽  
Elena Mihalceanu ◽  
Radu Pintilie ◽  
Mircea Onofriescu ◽  
...  
Keyword(s):  
Surgical Management ◽  
Pregnancy Termination ◽  
Color Doppler ◽  
Transvaginal Ultrasound ◽  
Case Series ◽  
First Trimester ◽  
The Body ◽  
Inadequate Response ◽  
Caesarean Scar ◽  
Caesarean Scar Pregnancy

Abstract Background There is no clear consensus on the management of caesarean scar pregnancy (CSP), a complex and life-threatening condition. The objective of this study was to present a novel approach to management of CSP that combines medical therapy of multidose methotrexate and mifepristone with active surgical management by uterine curettage and consecutive local haemostasis. Case presentation We report on a prospective case series of six women with first trimester pregnancy, in whom the diagnosis of CSP was confirmed by 2D and color Doppler transvaginal ultrasound and serial hormone chorionic gonadotropin (hCG) testing. Women were between 23 and 36 years old and had at least one previous delivery by caesarean. At admission, gestational age ranged between 6 to 14 weeks, and serum hCG levels between 397 and 23,000 mUI/ml. Upon decision of pregnancy termination, medical management was undertaken in all cases and 1 mg/kg systemic Methotrexate was administered between 1 and 5 daily doses. Mifepristone was part of the treatment in cases with live pregnancy. Surgical management was employed for the cases were an embryo was seen by ultrasound, being prompted by inadequate response to Methotrexate and/or signs of miscarriage with vaginal bleeding. Curettage combined with local isthmic balloon or vaginal pack tamponade prevented further complications. High treatment rates with preservation of fertility was achieved in all patients except one who underwent hysterectomy for invasive placentation. Ultrasound and hCG levels surveillance ensured that the resolution of pregnancy was achieved. Conclusion Women with history of delivery by caesarean section should be carefully monitored in future pregnancies for prompt diagnosis of CSP. Early diagnosis of CSP allows selection of successful conservative therapy. Through this case series we contribute with our experience to the body of knowledge about the management of this serious complication of early pregnancy.

Reply to “Caesarean scar pregnancy: Look at a leopard through a tube”

2021 ◽  
Vol 61 (1) ◽  
Author(s):  
Natalie Drever ◽  
Scott Gregory Petersen ◽  
Julia Bertolone ◽  
Sarah Janssens
Keyword(s):  
Caesarean Scar ◽  
Caesarean Scar Pregnancy
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