scholarly journals Clinical case of expectant tactics of scar pregnancy and childbirth in the III trimester

2021 ◽  
pp. 27-32
Author(s):  
O.D. Shchurevska ◽  
N.P. Honcharuk
Keyword(s):  
Cesarean Section ◽  
Ultrasound Examination ◽  
Placenta Previa ◽  
First Trimester ◽  
Uterine Wall ◽  
The Body ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Pregnancy And Childbirth ◽  
Future Fertility

One of the rare complications of a previous cesarean section is pregnancy with implantation in the area of the postoperative scar. The literature describes isolated reports of this pathology, which relate to early pregnancy. The forecast and tactics of their management are debatable issues.This article presents a case of successful monitoring of pregnancy and childbirth of a patient with a combined pathology: the placenta in the area of the cesarean scar with its diastase and central placenta previa with the germination of the uterine wall.The 34-year-old pregnant woman (III pregnancy and II expected childbirth) during ultrasound examination central a placenta previa was diagnosed. It had ingrowth into the uterine wall creating defect of the cesarean scar. Informed about the possible risks, patient strongly insisted on prolonging the pregnancy. Since 23 weeks she was in an obstetric hospital for the possibility of urgent surgery. Within 37 weeks, a planned caesarean section was performed by bottom access with subsequent extirpation of the uterus. Literary data from different countries almost all describe the completion of cesarean scar pregnancy in the first and second trimesters. Due to the rarity, heterogeneity of groups and the lack of a single protocol for the management of this pathology, combined or modified approaches to treatment are more often used. Primary prevention should begin at the stage of preventing a high frequency of cesarean section, reviewing the indications for it and conducting a truly justified surgery. Preconceprion care should be mandatory when planning the next pregnancy. Great attention should be paid to the localization of the chorion in the protocol of the screening ultrasound examination of the first trimester if there is uterine scar. In the case of a cesarean scar pregnancy, we cannot recommend an expectant tactics at this stage. Any method that eliminates cesarean scar pregnancy, especially in the early term, will saving the body and future fertility, as well as reduces morbidity and mortality.

First-Trimester Cesarean Scar Pregnancy Evolving Into Placenta Previa/Accreta at Term

2005 ◽  
Vol 24 (11) ◽  
pp. 1569-1573 ◽  
Author(s):  
Jara Ben Nagi ◽  
Dede Ofili-Yebovi ◽  
Mike Marsh ◽  
Davor Jurkovic
Keyword(s):  
Placenta Previa ◽  
First Trimester ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar

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.

scholarly journals Cesarean Scar Pregnancy Successfully Managed to Term: When the Patient Is Determined to Keep the Pregnancy

Medicina ◽  
2020 ◽  
Vol 56 (10) ◽  
pp. 496
Author(s):  
Ranko Kutlesic ◽  
Marija Kutlesic ◽  
Predrag Vukomanovic ◽  
Milan Stefanovic ◽  
Danka Mostic-Stanisic
Keyword(s):  
Early Diagnosis ◽  
Cesarean Section ◽  
Placenta Previa ◽  
Expectant Management ◽  
Severe Bleeding ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Uterine Incision ◽  
Gestational Sac

Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy, defined as the implantation of the gestational sac at the uterine incision scar of the previous cesarean section. This condition is associated with severe maternal and fetal/neonatal complications, including severe bleeding, rupture of the uterus, fetal demise, or preterm delivery. In view of these, early diagnosis allows the option of termination of pregnancy. In this case report, we present a patient with a cesarean scar pregnancy who was diagnosed at the sixth week of gestation but declined early termination of the pregnancy and was managed to the 38th week. Placenta previa was confirmed in the second trimester. A planned cesarean section was performed that resulted in the birth of a live full-term neonate. Intraoperatively, placenta percreta was diagnosed, and due to uncontrollable bleeding, a hysterectomy was performed. The postoperative course was uneventful. In cases where an early diagnosis of CSP is made, women should be counseled that this will almost certainly evolve to placenta previa, and the associated risks should be explained. Close follow-up of CSP is mandatory if expectant management is selected. Further studies are needed for definitive conclusions and to determine the risks of expectant management.

scholarly journals Cesarean Scar Pregnancy Treated by Artery Embolization Combined with Diode Laser: A Novel Approach for a Rare Disease

Medicina ◽  
2021 ◽  
Vol 57 (5) ◽  
pp. 411
Author(s):  
Felice Sorrentino ◽  
Vincenzo De Feo ◽  
Guglielmo Stabile ◽  
Raffaele Tinelli ◽  
Maurizio Nicola D’Alterio ◽  
...  
Keyword(s):  
Diode Laser ◽  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Artery Embolization ◽  
Artery Ligation ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Dilation And Curettage ◽  
Management Protocol ◽  
Future Fertility

Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy which represents a consequence of a previous cesarean section. It is associated with major maternal morbidity and mortality and has potential implications on future fertility. Because of possible serious complications, CSP should be swiftly diagnosed and treated. There is no management protocol for this rare, life-threatening condition, and each patient should be evaluated individually. Several types of conservative treatment have been used to treat cesarean scar pregnancy: dilation and curettage (D&C), excision of trophoblastic tissues, local or systemic administration of methotrexate, bilateral hypogastric artery ligation, and selective uterine artery embolization with curettage and/or methotrexate administration. In our study we present a cesarean scar pregnancy of a 40-year-old woman who was treated with angiographic uterine artery embolization (UAE) followed by hysteroscopic diode laser resection. Our combined UAE–hysteroscopic laser surgery appears to offer an effective, safe, and minimally invasive surgical treatment.

scholarly journals Conservative Surgical Treatment of a Case of Placenta Accreta

2018 ◽  
Vol 40 (08) ◽  
pp. 494-496 ◽  
Author(s):  
Ismail Biyik ◽  
Fatih Keskin ◽  
Elif Keskin
Keyword(s):  
Cesarean Section ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Placental Tissue ◽  
Uterine Wall ◽  
Elective Cesarean Section ◽  
Triple P ◽  
Cesarean Hysterectomy ◽  
Uterine Incision ◽  
Fertility Sparing

AbstractPlacenta accreta syndromes are associated with increased maternal mortality and morbidity. Cesarean hysterectomy is usually performed in cases of placenta accreta syndrome. Fertility sparing methods can be applied. In the present study, we report a successful segmental uterine resection method for placenta accreta in the anterior uterine wall in a cesarean section case. A 39-year-old woman underwent an elective cesarean section at 38 + 2 weeks. A placental tissue with an area of 10 cm was observed extending from the anterior uterine wall to the serosa, 2 cm above the uterine incision line. The placental tissue was removed with the help of monopolar electrocautery. The uterine incision was continuously sutured. The patient was discharged on the second postoperative day. The placental pathology was reported as placenta accreta. The American College of Obstetricians and Gynecologists (ACOG) generally recommends cesarean section hysterectomy in cases of placenta accreta because removal of placenta associated with significant hemorrhage. Conservative and fertility sparing methods include placenta left in situ, cervical inversion technique and triple-P procedure. There are several studies reporting that segmental uterine resection is performed with and without balloon placement or artery ligation. Segmental uterine resection may be an alternative to cesarean hysterectomy to preserve fertility or to protect the uterus in cases of placenta accreta when there is no placenta previa.

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.

The possibility of high-precision ultrasound diagnosis of placenta ingrowth into the uterine scar after cesarean section

2020 ◽  
Author(s):  
V.N. Demidov, A.I. Gus, T.A. Yarygina
Keyword(s):  
Statistical Analysis ◽  
Cesarean Section ◽  
Pregnant Women ◽  
High Precision ◽  
Ultrasound Examination ◽  
Placenta Previa ◽  
Ultrasound Diagnosis ◽  
Lower Segment ◽  
Uterine Scar

Our statistical analysis, based on ultrasound examination of 7069 pregnant women, showed that both in the absence and in the presence of a scar on the uterus in the region of its lower segment, the placenta in the 3rd trimester of pregnancy was located extremely rarely, only in 0.1%. It was either primarily located in other parts of the uterus, or migrated from the lower segment of the uterus towards the bottom. In the case of the location of the placenta in this area, its ingrowth was not observed only in 2.3% of women. The main ultrasound signs of ingrowth of the placenta into the scar was the absence of its migration, as well as the presence of a combination of placenta previa with its localization in the scar zone. From the data obtained, it follows that the sensitivity of ultrasound diagnosis of placental accreta was 97.7%, and the specificity was 99.9%. According to our data, ingrown placenta in most cases can be delivered as early as 14–19 weeks, and the time spent on detecting this pathology usually does not exceed one minute.

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