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.
ObjectiveThe aim of this study was to compare position-related changes in fetal middle cerebral artery (MCA) Doppler pulsatility indices (PI).MethodsA prospective study of 41 women with conditions associated with placental-pathology (chronic hypertension, pregestational diabetes, and abnormal analytes) and 34 women without those conditions was carried out. Fetal MCA Doppler velocity flow waveforms were obtained in maternal supine and left lateral decubitus positions. MCA PI Δ was calculated by subtracting the PI in the supine position from the PI in the left lateral position. Secondary outcomes included a composite of adverse perinatal outcomes (fetal growth restriction, oligohydramnios, and preeclampsia). χ2 and Student t-tests and repeated-measures analysis of variance were used.ResultsMCA PI Δ was significantly less for high-risk pregnant women ([P = 0.03]: high risk, left lateral PI, 1.90 ± 0.45 vs. supine PI, 1.88 ± 0.46 [Δ = 0.02]; low risk, left lateral PI, 1.90 ± 0.525 vs. supine PI, 1.68 ± 0.40 [Δ = 0.22]). MCA PI Δ was not significantly different between women who had a composite adverse outcome and women who did not have a composite adverse outcome (P = 0.843).ConclusionOur preliminary study highlights differences in position-related changes in fetal MCA PI between high-risk and low-risk pregnancies. These differences could reflect an attenuated ability of women with certain risk factors to respond to physiologic stress.
INTRODUCTION:
Evidence has shown that “brain sparing” phenomenon can be replicated using maternal position as a physiological stress. Our study's objective is to ascertain if changes in Middle Cerebral Artery (MCA) Doppler pulsatility indices (PI) due to physiological stress caused by maternal position correlates with adverse perinatal outcomes in low risk and in high risk patients.
METHODS:
A prospective cohort study of singleton, nonanomalous pregnancies with chronic hypertension or pregestational diabetes, and low risk pregnancies between 18 and 36 weeks gestation. Pregnancies with Rh isoimmunizations, fetal growth restriction, maternal cardiac disease, smoking or drug use history were excluded. Fetal doppler velocimetry indices were obtained from the fetal MCA in maternal supine and left lateral decubitus position. ANOVA was used to compare demographics between cohorts and composite of adverse perinatal outcomes, which included fetal growth restriction, oligohydramnios and preeclampsia.
RESULTS:
The delta of MCA Doppler PI between the two maternal positions did not correlate with adverse perinatal outcome (p= 0.409). 89 patients were included. There were 34 (38.2%) women with adverse outcomes; 22 (64.7%) patients were from the low risk group and 12 (35.3%) patients were from the high risk group.
CONCLUSION:
Our preliminary study did not demonstrate correlation between delta fetal MCA Doppler indices and composite outcome. The limitation of this study was that it was not powered for the finding of high composite adverse outcome in the “low risk” group, which might suggest underlying unknown risks. More data is needed in order to address the significance of fetal MCA Doppler indices changes.
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