A Case of Misdiagnosed Cesarean Scar Pregnancy with a Viable Birth at 28 Weeks

Nukaga, Sakiko; Aoki, Shigeru; Kurasawa, Kentaro; Takahashi, Tsuneo; Hirahara, Fumiki

doi:10.1155/2014/375685

Cited by 5 publications

(6 citation statements)

References 10 publications

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“…A CSP occurs when the pregnancy implants on the uterine scar or in the niche after a previous CS 7 . Although a CSP is often considered for pregnancy termination, some cases have reportedly progressed towards an intrauterine pregnancy and resulted in viable births [8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

Definition and sonographic reporting system for Cesarean scar pregnancy in early gestation: modified Delphi method

Jordans

Verberkt

Leeuw

et al. 2022

Ultrasound in Obstet & Gyne

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Objective To develop a standardized sonographic evaluation and reporting system for Cesarean scar pregnancy (CSP) in the first trimester, for use by both general gynecology and expert clinics. Methods A modified Delphi procedure was carried out, in which 28 international experts in obstetric and gynecological ultrasonography were invited to participate. Extensive experience in the use of ultrasound to evaluate Cesarean section (CS) scars in early pregnancy and/or publications concerning CSP or niche evaluation was required to participate. Relevant items for the detection and evaluation of CSP were determined based on the results of a literature search. Consensus was predefined as a level of agreement of at least 70% for each item, and a minimum of three Delphi rounds were planned (two online questionnaires and one group meeting). Results Sixteen experts participated in the Delphi study and four Delphi rounds were performed. In total, 58 items were determined to be relevant. We differentiated between basic measurements to be performed in general practice and advanced measurements for expert centers or for research purposes. The panel also formulated advice on indications for referral to an expert clinic. Consensus was reached for all 58 items on the definition, terminology, relevant items for evaluation and reporting of CSP. It was recommended that the first CS scar evaluation to determine the location of the pregnancy should be performed at 6–7 weeks' gestation using transvaginal ultrasound. The use of magnetic resonance imaging was not considered to add value in the diagnosis of CSP. A CSP was defined as a pregnancy with implantation in, or in close contact with, the niche. The experts agreed that a CSP can occur only when a niche is present and not in relation to a healed CS scar. Relevant sonographic items to record included gestational sac (GS) size, vascularity, location in relation to the uterine vessels, thickness of the residual myometrium and location of the pregnancy in relation to the uterine cavity and serosa. According to its location, a CSP can be classified as: (1) CSP in which the largest part of the GS protrudes towards the uterine cavity; (2) CSP in which the largest part of the GS is embedded in the myometrium but does not cross the serosal contour; and (3) CSP in which the GS is partially located beyond the outer contour of the cervix or uterus. The type of CSP may change with advancing gestation. Future studies are needed to validate this reporting system and the value of the different CSP types. Conclusion Consensus was achieved among experts regarding the sonographic evaluation and reporting of CSP in the first trimester. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

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Section: Introductionmentioning

confidence: 99%

Definition and sonographic reporting system for Cesarean scar pregnancy in early gestation: modified Delphi method

Jordans

Verberkt

Leeuw

et al. 2022

Ultrasound in Obstet & Gyne

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“…Surgical modalities are uterine curettage, resection of the abnormal area which showed appearances of trophoblastic tissue with laparoscopy or laparotomy. A successful hysteroscopic management of a CSP after failure of curettage and methotrexate treatment had been described by Chao et al 6…”

Section: Sites Of Implantation In Ectopic Pregnancymentioning

confidence: 98%

Caesarean scar ectopic pregnancy and laparoscopy: a rendezvous

Dutta,

Koley,

Kumaradasan

et al. 2023

Int J Reprod Contracept Obstet Gynecol

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Caesarean scar pregnancy (CSP) is defined as an implantation of pregnancy in a fibrous tissue scar of a previous caesarean section, one of the rarest forms of ectopic pregnancy which can be life threatening. The incidence of CSP is steadily rising in view of increasing caesarean section rates. A very high index of clinical suspicion is required for the diagnosis and further management. As with other ectopic pregnancies, caesarean scar ectopic pregnancy pose a greater risk for maternal haemorrhage and ultimately maternal mortality. Through this case report, we demonstrated the laparoscopic management of a CSP.

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“…Despite the fact that termination of pregnancy is most often the recommended approach to CSP, there have been a few reports of intra-uterine pregnancies that resulted in viable births. 13,14 The ultrasound criteria for CSP have been redefined recently, and now propose transvaginal ultrasound as the imaging technique of choice at this early stage. 15 Determination of the exact location of the gestational sac and invasion of the placenta is necessary to estimate the patient's risk and to advise whether to terminate or to continue the pregnancy.…”

Section: Introductionmentioning

confidence: 99%

“…It is likely that this percentage will rise as a result of growing awareness and more accurate diagnosis. Despite the fact that termination of pregnancy is most often the recommended approach to CSP, there have been a few reports of intra‐uterine pregnancies that resulted in viable births 13,14 …”

Section: Introductionmentioning

confidence: 99%

Outcomes of Cesarean Scar Pregnancies in Early Gestation According to the New Delphi Consensus Criteria

Pekar-Zlotin

Zur-Naaman

Maymon

et al. 2023

J of Ultrasound Medicine

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ObjectivesClinical evaluation of the new Delphi consensus definition of cesarean scar pregnancy (CSP) in early gestation.MethodsA retrospective cohort of 36 women diagnosed with CSP and treated with combined local and systemic methotrexate (MTX) between 2008 and 2021. The CSPs were classified according to the new Delphi consensus criteria into three subgroups based on the depth of the gestational sac herniation in the sagittal plane. Subgroup A included 8 (22.2%) cases in which the largest part of the gestational sac protruded toward the uterine cavity. Subgroup B included 22 (61.1%) cases in which the largest part of the gestational sac was embedded in the myometrium, and subgroup C included 6 (16.7%) cases in which the gestational was partially located outside the outer contour of the cervix or uterus.ResultsThe β‐HCG level upon admission was significantly lower in subgroup A than in subgroups B or C (11,075 ± 7109, 18,787 ± 16,585, and 58,273 ± 55,267 mIU/mL, respectively, P = .01). All subgroup C patients had repeated courses of MTX and surgical interventions (laparotomy, uterine artery embolization, and operative hysteroscopy) at double the rate of subgroups A or B (100, 50, and 40.9%, respectively, P = .036). The duration of hospitalization was significantly shorter in subgroup A than in subgroups B or C (1.9 ± 1.5, 2.1 ± 1.1, and 5.4 ± 4.9 days, P = .01).ConclusionsThe outcome according to Delphi consensus criteria for defining CSP in early gestation has implications for clinical decision‐making, patient care, and the follow‐up of CSP.

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A Case of Misdiagnosed Cesarean Scar Pregnancy with a Viable Birth at 28 Weeks

Cited by 5 publications

References 10 publications

Definition and sonographic reporting system for Cesarean scar pregnancy in early gestation: modified Delphi method

Definition and sonographic reporting system for Cesarean scar pregnancy in early gestation: modified Delphi method

Caesarean scar ectopic pregnancy and laparoscopy: a rendezvous

Outcomes of Cesarean Scar Pregnancies in Early Gestation According to the New Delphi Consensus Criteria

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