Catastrophic consequences of a caesarean scar pregnancy missed on ultrasound

Collins, Kelly; Kothari, Alka

doi:10.1002/j.2205-0140.2015.tb00222.x

Cited by 15 publications

(15 citation statements)

References 51 publications

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“…As in this study data, early diagnosis appropriate treatment is instrumental in reducing the risk of serious complications from CSP . Delayed diagnosis of CSP is reported to be common and consequences of misdiagnosis can be catastrophic . Our data is consistent, showing late diagnosis may have contributed to increased risk of complications in two cases.…”

Section: Discussionsupporting

confidence: 81%

Caesarean scar ectopic pregnancy: Experience from an Australian tertiary centre

Drever

Bertolone

Shawki

et al. 2020

Aust NZ J Obst Gynaeco

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Background:Despite the rising incidence of caesarean scar pregnancy (CSP), as yet there are no consensus or evidence-based guidelines for management.Aims: To review diagnosis, treatment and management of all women with CSP over a 5 year period at Mater Mothers' Hospital, Brisbane, Australia. Materials and methods:Retrospective cohort study of CSP between 2013-2018.Data reviewed included demographics, presenting symptoms, gestational age, ultrasound findings, human chorionic gonadotrophin levels, treatment success, complications, and if available, subsequent pregnancy outcomes.Results: Twenty-eight women were treated for CSP during the study period. Initial diagnosis was delayed in ten (36%). Overall success rates of initial treatment were 22/28 (79%). Of the six cases of failed treatment, five had been treated with systemic methotrexate alone. All women requiring further intervention had fetal pole present, and 50% had fetal cardiac activity. Failure rate of systemic methotrexate alone was 5/11 (45%). Eleven women deemed appropriate for conservative management did not require further treatment or experience complications. Nine women had data available for subsequent pregnancies, of whom two developed placenta accreta. Conclusion:This study provides data that may assist in guideline development and decision-making for management of CSP. Conservative management in carefully selected women appeared to be safe. Nearly half of women treated with systemic methotrexate alone required another treatment modality, suggesting a role for intralesional treatment, particularly in the presence of fetal pole ± fetal cardiac activity. More than one in five women with documented subsequent pregnancies were diagnosed with placenta accreta. K E Y W O R D Scaesarean scar pregnancy, ectopic, methotrexate, caesarean section, placenta accreta

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Section: Discussionsupporting

confidence: 81%

Caesarean scar ectopic pregnancy: Experience from an Australian tertiary centre

Drever

Bertolone

Shawki

et al. 2020

Aust NZ J Obst Gynaeco

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“…CSEP can be mistaken for spontaneous miscarriage in progress [11,13] or cervical ectopic pregnancy [13]. In cervical pregnancy, unlike CSEP, there would be a layer of myometrium visible between the bladder and the gestational sac and bleeding as the presenting symptom is much more substantial [5,6,11,13]. The uterus is empty with an endometrial stripe, the gestational sac presents predominantly within the cervix, giving an hour-glass shape of the uterus with a ballooned cervical canal (see Figure 7) [5,6,14].…”

Section: Differential Diagnosesmentioning

confidence: 99%

“…The uterus is empty with an endometrial stripe, the gestational sac presents predominantly within the cervix, giving an hour-glass shape of the uterus with a ballooned cervical canal (see Figure 7) [5,6,14]. In case of spontaneous miscarriage in progress, an avascular gestational sac is seen in the cervical canal indicating that it has been detached from its implantation site, in contrast to the well-perfused CSEP located in the anterior lower uterine wall [5,13]. A significant fall in serum beta-hCG level would also be noticed in a miscarriage.…”

Section: Differential Diagnosesmentioning

confidence: 99%

Caesarean Scar Ectopic Pregnancy

Tadesse¹

2020

Non-Tubal Ectopic Pregnancy

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Caesarean scar ectopic pregnancy (CSEP) is one of the rarest forms of ectopic pregnancy. It is characterised by a gestation implanted in a caesarean section scar and surrounded by the myometrium and the fibrous tissue of the scar. With rising caesarean delivery rates and widespread use of ultrasound in early pregnancy, there is a parallel upward trend in the incidence of CSEP. The most significant risk associated with a CSEP is an early uterine rupture with life-threatening maternal haemorrhage leading to hysterectomy and loss of reproductive potential. An early diagnosis can offer conservative treatment options capable of preserving the uterus. This chapter discusses the clinical presentation, diagnosis and evidence-based treatment options of CSEP.

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“…Mothers with CSP are confronted with risks, such as unpredictable life-threatening massive bleeding and uterine rupture, when misdiagnosed ( 4 ). Hence, there is an urgent need to perform an early accurate diagnosis and select the optimal treatment for CSP, in order to avoid hysterectomy due to uterine rupture and life-threatening massive bleeding ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Analysis of the Treatment of Cesarean Scar Pregnancy by High-Intensity Focused Ultrasound, Uterine Artery Embolization and Surgery

et al. 2020

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Objective: This study aims to retrospectively analyze the clinical curative effects of surgery, uterine artery embolization (UAE), and high-intensity focused ultrasound (HIFU) in order to provide the theory and evidences for selecting the optimal treatment for cesarean scar pregnancy (CSP). Methods: Women with CSP were treated with surgery (laparoscopic, hysteroscopy, and hysteroscopy–laparoscopic surgery), UAE combined with curettage, and HIFU combined with curettage. The general conditions and therapeutic effects, including vital signs during the operation, discomfort of discharge, cure rate, total blood loss, decline in the rate of hCG, and hospital stay, were compared and analyzed. Results: For the 154 CSP patients, the cure rate of surgery ( n = 95) was 97.89%, the cure rate of UAE ( n = 32) was 43.74%, and the cure rate of HIFU ( n = 27) was 70.37%. The difference was statistically significant ( P < 0.05). Furthermore, the hCG level of surgical patients quickly declined, whereas HIFU slowly declined. The difference between the decline rate of hCG and mean hospitalization time was statistically significant ( P < 0.05). UAE was good for CSP with gestational age <60 days and diameter of gestational sac <40 mm. Furthermore, HIFU was well for CSP patients with a gestational age of <55 days and a gestational sac diameter of <30 mm. Surgery was suitable for any type of these cases. Conclusion: CSP patients with short gestational age and small gestational sac can be treated with surgery, UAE, and HIFU, and achieve safe and effective therapeutic effects. Surgery is also a good choice for CSP for patients with a long gestational age, a large gestational sac diameter, high levels of hCG, or an ample blood supply.

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Catastrophic consequences of a caesarean scar pregnancy missed on ultrasound

Cited by 15 publications

References 51 publications

Caesarean scar ectopic pregnancy: Experience from an Australian tertiary centre

Caesarean scar ectopic pregnancy: Experience from an Australian tertiary centre

Caesarean Scar Ectopic Pregnancy

A Retrospective Analysis of the Treatment of Cesarean Scar Pregnancy by High-Intensity Focused Ultrasound, Uterine Artery Embolization and Surgery

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