The use of vitamin K1 preoperatively might result in warfarin resistance and discontinuation of warfarin therapy before selective CS might be more appropriate than application of vitamin K1. The "bridging" anticoagulation treatment which combines oral warfarin and subcutaneous LMWH might be more effective and safer than single oral warfarin therapy for patients with mechanical heart valve replacement during postoperative period, no matter selective or emergency CS. The safety of low-dose oral warfarin therapy throughout pregnancy is still under controversy.
Rationale:The incidence of molar pregnancy in the cesarean scar is exceedingly low, however, the disease may carry a high risk of uncontrolled hemorrhage or uterine rupture. So far managements of this disease were rarely reported in literature.Patient concerns:We reported a 28-year-old woman presented to our hospital with a complaint of amenorrhea for 48 days and vaginal bleeding for 3 days.Diagnosis:Transvaginal ultrasonography, serum hCG and pelvic MRI confirmed the cesarean scar pregnancy.Interventions:The patient underwent bilateral uterine arterial embolization and suction evacuation.Outcomes:The postoperative histologic examination of the tissue revealed a partial hydatidiform mole.Lessons:Molar pregnancy in the cesarean scar is tough to differentiate from normal cesarean scar pregnancy with serum hCG, sonogram or MRI. This case suggested us that it was necessary to perform a histological examination of postoperative specimen for cesarean scar pregnancy.
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