Cesarean Scar Ectopic Pregnancies

Rotas, Michael; Haberman, Shoshana; Levgur, Michael

doi:10.1097/01.aog.0000218690.24494.ce

Cited by 556 publications

(308 citation statements)

References 49 publications

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“…We know from literature that CSEPs may present from as early as 5 to 6 weeks to as late as 16 weeks' gestation [5]. Clinical presentation varies from light, painless vaginal bleeding (39% of cases), but the bleeding may also be associated with mild to moderate pain (16% of cases) [6], as was the case with our patients. Nine percent of patients will present with only abdominal pain, whilst 37% will be completely asymptomatic [5], hence the need for a high index of suspicion whilst scanning patients who have had a previous CS.…”

Section: Discussionsupporting

confidence: 69%

Caesarean Scar Ectopic Pregnancies—Case Series from a District General Hospital

Akhanoba¹,

Awala²,

Tony³

2017

OJOG

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Caesarean Scar Ectopic Pregnancy (CSEP) is a rare, but potentially catastrophic complication of a previous Caesarean Section (CS) birth. This is a review of 5 cases of CSEP managed in our Early Pregnancy Unit at Watford General Hospital within a 10-month period. Two patients had only one previous CS, whilst 2 had two and the last had 3 previous CS. All our patients presented within the first trimester of pregnancy (range 6 to 11 weeks' gestation) with light vaginal bleeding; 4 of them had associated mild to moderate abdominal pain. All were diagnosed using transvaginal ultrasound scan. Three of our patients were managed surgically by Suction Evacuation under Ultrasound guidance and insertion of a Foley's catheter prophylactically for tamponade in order to reduce blood loss both intra-and post-operatively. One of our patients had a heterotopic pregnancy with a viable intrauterine pregnancy and a live CSEP. She declined any intervention so she was managed conservatively with weekly Consultant appointments and scans. There was a subsequent demise of the CSEP and she continued with a singleton pregnancy. None of our patients were managed medically. There is no absolute consensus on diagnostic criteria and there is no standard management protocol so each woman should be given all the available information and the opportunity to decide on the management of her pregnancy. The risk of a CSEP in a subsequent pregnancy should be part of the consent process for CS.

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Section: Discussionsupporting

confidence: 69%

Caesarean Scar Ectopic Pregnancies—Case Series from a District General Hospital

Akhanoba¹,

Awala²,

Tony³

2017

OJOG

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“…The clinical presentation of CSP was nonspecific at presentation and the common symptom was vaginal bleeding with or without abdominal pain [19]. Some patients had heavy bleeding during or after dilatation and curettage.…”

Section: Discussionmentioning

confidence: 99%

Identifying risk factors for cesarean scar pregnancy: a retrospective study of 79 cases

Shi¹,

Zhang²,

Qi³

et al. 2018

Ginekol Pol

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Objectives:To explore the possible risk factors for cesarean scar pregnancy (CSP), the incidence of which is increasing rapidly in China. Material and methods:79 patients with CSP and 69 non-CSP expectant mothers with at least 1 previous cesarean section were employed in the study. The obstetric histories of the participants were collected and analyzed using Chi square test. Results:We found that 77.2% CSP patients had ≥ 3 pregnancies and only 36.2% women had ≥ 3 pregnacies in non-CSP group. During the previous cesarean delivery, 21.5% of CSP patients had entered the first stage of labor, which was 43.5% in non-CSP group (P < 0.05). Cephalopelvic disproportion occurred in 51.9% of CSP patients, which was significantly higher than that (23.2%) in non-CSP group (P < 0.01). 11.4% of CSP patients had undergone cesarean section due to breech and shoulder presentation in the past, which was only 1.4% in non-CSP group. However, no significance was noted (P > 0.05). We did not find significant differences between the CSP and non-CSP patients in maternal age, multiple cesarean sections, gestational age, emergency or elective caesarean section. Conclusions:Multiple pregnancies, absence of the first stage of labor, and cephalopelvic disproportion might be the risk factors for the occurrence of CSP.

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“…5 Sonographic criteria for diagnosing CSP include an empty uterus without contact with the gestational sac; a visibly empty cervical canal; the presence of the gestational sac with or without a fetal pole and with or without fetal cardiac activity (depending on the gestational age) in the anterior segment of the uterine isthmus; and the absence of or a defect in the myometrial tissue between the bladder and the gestational sac. 1,7 All cases of CSP in the current series fulfilled these criteria.…”

Section: Lscs = Lower Segment Caesarean Section; β-Hcg = β-Human Chormentioning

confidence: 99%