A case report of a misdiagnosed cesarean scar pregnancy in a hemodynamically compromised patient

Rivera-Rodríguez, A.J.; Jiménez-Zarazúa, Omar; Castaldi-Bermúdez, L.A.; Vélez-Ramírez, Lourdes Noemí; Coronel-Ciocca, O. Camacho; Romero-Frances, M.A.; Becerra-Baeza, A.M.; Mondragón, Jd.

doi:10.1016/j.ehpc.2019.200344

“…As with CP, maternal outcomes depend on diagnosis; the earlier, the better. If unrecognized or delayed, sequelae may include uterine rupture, major haemorrhage, and emergency hysterectomy [5].…”

Section: Introductionmentioning

confidence: 99%

Reconstructing the Evolutionary History of Nucleotide-Binding Site (NBS) Genes in Euasterids

Anthony¹

2022

IJESNR

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Caesarean scar and cervical ectopic pregnancies are rare but life-threatening complications of early pregnancy. Diagnosis may be difficult, particularly in discerning one from the other, as both may share early clinical and ultrasonographic features. Although treatment strategies are similar at the early stage of management, pathways of care soon diverge, which means the correct diagnosis is crucial to ensure the most appropriate decisions for ongoing decision-making. We present a caesarean scar ectopic case, initially diagnosed as early cervical pregnancy. The case highlights the difficulty that may confound the critical distinction between these two early presentations of pregnancy complication. It goes on to describe successful management using single dose systemic methotrexate despite variance with standard treatment protocols. Finally, we present a hypothesis to explain why diagnostic ambiguity may relate to current trends of best obstetric practice.

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“…As with CP, maternal outcomes depend on diagnosis; the earlier, the better. If unrecognized or delayed, sequelae may include uterine rupture, major haemorrhage, and emergency hysterectomy [5].…”

Section: Introductionmentioning

confidence: 99%

Uterine Scar Ectopic Pregnancy – A Rare Case of Misdiagnosis Reflecting Changes in Contemporary Obstetric Practice

Aali¹

2022

JOJCS

0

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Caesarean scar and cervical ectopic pregnancies are rare but life-threatening complications of early pregnancy. Diagnosis may be difficult, particularly in discerning one from the other, as both may share early clinical and ultrasonographic features. Although treatment strategies are similar at the early stage of management, pathways of care soon diverge, which means the correct diagnosis is crucial to ensure the most appropriate decisions for ongoing decision-making. We present a caesarean scar ectopic case, initially diagnosed as early cervical pregnancy. The case highlights the difficulty that may confound the critical distinction between these two early presentations of pregnancy complication. It goes on to describe successful management using single dose systemic methotrexate despite variance with standard treatment protocols. Finally, we present a hypothesis to explain why diagnostic ambiguity may relate to current trends of best obstetric practice.

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“…Curettage alone or systemic methotrexate administration, as well as expectant management, are strongly considered unsuitable because of the high morbidity and mortality maternal risks (hemorrhage, perforation, development of uterine arteriovenous malformation, etc. [ 7 , 8 , 9 , 10 , 11 ]). However, there is no consensus for the optimal treatment regime, and different situations require different approaches [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Uterine Artery Embolization Combined with Subsequent Suction Evacuation as Low-Risk Treatment for Cesarean Scar Pregnancy

Bohîlțea

¹

,

Ducu

²

,

Mihai³

et al. 2021

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Objective: The aim of this study is to propose a standardized management of care for patients diagnosed with cesarean scar pregnancy (CSP). There are two types of CSP: Type 1 (on the scar) vs. type 2 (in the niche). To date there is no international standard to predict the extent of invasion or the optimal management of CSP. Materials and methods: We used intramuscular methotrexate injection followed by uterine artery embolization combined with suction evacuation as a conservative approach for the treatment of seven patients diagnosed with CSP. Our inclusion criteria, to be satisfied simultaneously, were established as follows: (1) patients with CSP; (2) early gestational age ≤ 9 weeks, and (3) written consent of the proposed treatment of the patient. Results: This course of treatment produced a positive outcome in all cases. We did not have any complications (e.g., emergency hysterectomy, perforation of the uterine cavity, severe hemorrhage, or endometritis) during the procedures or in the follow-up. The most important predictors of successful management are early diagnosis of CSP and orientation of the invasive trophoblast opposite to the scar. Conclusions: The main finding from this series of cases is that associating systemic methotrexate and uterine artery embolization provides efficient and low-risk management of CSP. This treatment regime is adequate for both types of CSPs. We consider that early localization diagnosis of pregnancy following a cesarean delivery is mandatory for CSP morbidity prevention.

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A case report of a misdiagnosed cesarean scar pregnancy in a hemodynamically compromised patient

Cited by 3 publications

References 13 publications

Reconstructing the Evolutionary History of Nucleotide-Binding Site (NBS) Genes in Euasterids

Reconstructing the Evolutionary History of Nucleotide-Binding Site (NBS) Genes in Euasterids

Uterine Scar Ectopic Pregnancy – A Rare Case of Misdiagnosis Reflecting Changes in Contemporary Obstetric Practice

Uterine Artery Embolization Combined with Subsequent Suction Evacuation as Low-Risk Treatment for Cesarean Scar Pregnancy

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