Cesarean Scar Ectopic Pregnancy: Case Series and Review of the Literature

Sadeghi, Homayoun; Rutherford, Thomas J.; Rackow, Beth W.; Campbell, Katherine; Duzyj, Christina M.; Guess, Marsha K.; Kodaman, Pinar H.; Norwitz, Errol R.

doi:10.1055/s-0029-1224874

Cited by 109 publications

(89 citation statements)

References 29 publications

(52 reference statements)

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“…Though the classification is different, in a larger study, Hwang et al [16] reported better success rates with D&E or D&E under laparoscopic guide. Also compared to 46% of success rate in D&E treatment group, our report showed more increased success rate with 64% [17]. Taken together, for successful evacuation, surgery at earlier gestational weeks is one of the determining prognostic factors.…”

Section: Discussionmentioning

confidence: 46%

The clinical efficacy of dilatation and evacuation therapy for cesarean scar pregnancy

Yang

Park

Chang

et al. 2011

Korean J Obstet Gynecol

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ObjectiveTo evaluate the therapeutic effi cacy of dilatation and evacuation (D&E) for cesarean scar pregnancy (CSP) and to determine prognostic factors. MethodsThis study was retrospectively performed in 68 women who had been diagnosed with CSP. The 56 CSP women were enrolled for whom D&E was the primary treatment. The patients were divided into two groups according to treatment outcomes. Women who received D&E only were defi ned as the success group and patients who required additional treatment were categorized as the failure group. Demographic, clinical, and sonographic characteristics according to treatment results were analyzed. ResultsAmong the total of 56, 36 (64%) women were treated by D&E only, and 20 (36%) women underwent additional treatments. There were no signifi cant difference in maternal age, gravida, number of previous cesarean section, initial symptoms, but signifi cant difference in parity (≥2), gestational age at diagnosis, serum ß-human chorionic gonadotropin level, postoperative stay, and time to resolution was present (P<0.05). On sonographic fi ndings, there was signifi cant difference in terms of fetal heart beat, hematoma and myometrial thickness of the implantation site (P <0.05). After multivariate regression, only myometrial thickness of the implantation site with a cut-off value of 1.75 mm was signifi cant. ConclusionD&E is an effective and safe treatment modality in selected cases of CSP. Consideration of prognostic factors before deciding treatment modalities can help to achieve better outcomes. Copyright © 2011. Korean Society of Obstetrics and GynecologyCesarean scar pregnancy is the rarest form among ectopic pregnancies, but its frequency is increasing due to recent increase in cesarean deliveries. Early diagnosis of cesarean scar pregnancy is most important, for it can give rise to grave complications such as uterine rupture or massive hemorrhaging, and thus have an effect on maternal morbidity or mortality rate [1]. Total hysterectomy has been a common treatment modality since this form of pregnancy has shown cases with initial manifestations of massive hemorrhage as an obstetrical emergency [2]. With advances in ultrasonography resolution, detection at an earlier gestational age and more accurate diagnosis became possible to enable various methods for preservation of fertility, such as systemic or lo-ORIGINAL ARTICLE Korean J Obstet Gynecol 2011;54(8):406-412 http://dx

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Section: Discussionmentioning

confidence: 46%

The clinical efficacy of dilatation and evacuation therapy for cesarean scar pregnancy

Yang

Park

Chang

et al. 2011

Korean J Obstet Gynecol

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“…Erken tanı konulmazsa maternal ölüm görülebilmektedir. Risk faktörleri arasında geçirilmiş sezaryen öyküsü, myomektomi, dilatasyon ve küretaj (D&C), histeroskopi gibi uterusta skara neden olabilecek işlemler yer almaktadır [1]. Genel olarak 5-6. haftalarda tanı almasına rağmen literatürde 15. haftada tanı alan skar gebeliği mevcuttur, gebelik haftası ilerledikçe spontan rüptür riski de artmaktadır [4].…”

Section: Discussionunclassified

“…Geçirilmiş sezaryen olgularında görülme oranı % 0.15' tir [1]. Fizyopatolojik neden olarak embriyonel dokuların uterusun skar olan bölgesinde penetrasyon kabiliyetinin daha yüksek olması gösterilmektedir [2].…”

Section: Introductionunclassified

“…Fizyopatolojik neden olarak embriyonel dokuların uterusun skar olan bölgesinde penetrasyon kabiliyetinin daha yüksek olması gösterilmektedir [2]. Daha önce myometriyumda skara neden olabilecek; myomektomi, dilatasyon ve küretaj (D&C), histeroskopi, sezaryen gibi işlemler sonrası skar gebeliği oluşabileceği ile ilgili yayınlar mevcuttur [1]. Skar gebeliği oluşan hastaların %54' ünde geçirilmiş sezaryen hikayesi mevcuttur [3].…”

Section: Introductionunclassified

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Cesarean scar pregnancy presenting with acute abdomen after coitus: A case report

Aksüt¹,

Yılmaz²,

Mavi³

et al. 2013

Pau Med J

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ÖzetSezaryen skar gebeliği son yapılan çalışmalara göre yaklaşık 2200 vakada bir görülen ektopik gebeliğin nadir bir formudur. Sezaryen skar gebeliğinin patofizyolojisinde uterusa uygulanmış operasyonlar rol oynamaktadır. Tanı yöntemi olarak en faydalı yöntem transvajinal ultrasonografidir. Tedavisinde dilatasyon ve küretaj, uterin arter embolizasyonu, laparatomi, laparoskopi, histerektomi, koruyucu cerrahi yöntemler veya metotreksat ve KCl gibi medikal tedaviler uygulanmaktadır. Burada koitus sonrası akut abdomen ile başvuran, rüptüre sezaryen skarı gebeliği olan bir vakanın tedavisi sunulmuştur. Yirmidokuz yaşında, gravida 2, parite 1 (sezaryen doğum), yaşayan 1 ve son adet tarihine (SAT) göre 12 hafta gebeliği olan hasta, koitus sonrası oluşan şiddetli kasık ağrısı şikayeti ile başvurdu. Hastanın acil serviste radyoloji bölümü tarafından yapılmış suprabupik USG: intrauterin FKA (+) tek canlı fetus izlenmiştir. Uterin kavite posteriorunda lineer ekojen bant batın içerisinde yaygın serbest sıvı izlenmiştir. Transvajinal ultrasonografide; uterus ön duvar bütünlüğü bozulmuştu, amniyotik kesenin ise rüptüre olduğu düşünülen alandan protrüde olduğu izlendi. Acil olarak laparatomi uygulandı. Sezaryen skarının rüptüre olduğu ve kesenin ise kavite dışında olduğu görüldü. Fetal dokular dışarı çıkarıldıktan sonra uterus çift kat olarak sütüre edildi. İlk trimesterde yapılan ultrasonografide dış gebelik olasılığı, özellikle pelvik ağrı varlığında, her zaman akılda tutulmalıdır. Ektopik gebelik tanısı alan hastalara, özellikle gözlem ve medikal tedavi uygulanan gruba mutlaka koitus yasağı önerilmelidir, burada sunulan vakada olduğu gibi, özellikle sezaryen skar dış gebeliklerinde koitus sonrası rüptüre olabileceği unutulmamalıdır. 2013;6(3):150-152 Anahtar sözcükler: Sezaryen skar gebeliği, uterus rüptürü, koitus. Pam Tıp Derg AbstractCesarean scar pregnancy is a rare form of ectopic pregnancy and seen aproximately 1 in 2200 cases. The operations that are applied to the uterus are known as the pathophysiological cause. Transvaginal ultrasound is the best efficacious method for diagnosis. Many therapeutic options such as dilatation and curettage, uterine artery embolization, laparatomy, laparoscopy, hysterectomy, and preventetive surgery, local or systemically administered methotrexate, KCL are available. In this paper, a case of cesarean scar pregnancy presenting with acute abdomen after coitus is presented. A 29 year-old woman, gravidity 2, parity 1, alive 1 was admitted to hospital with a severe abdominal pain that occured after coitus. Suprapubic ultrasonographic examination by radiologist was reported as "a single live fetus in the uterin cavity, and a linear echogenic band at the posterior of the uterin cavity, and a big amount of free fluid in abdomen." Transvaginal ultrasound revealed that the integrity of the anterior wall of the uterus was impaired, amniotic sac was protruted to the intraabdominal area from the ruptured zone. The patient underwent laparatomy immediately. The previous cesaeran's scar was ruptur...

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“…Pain and bleeding are the most common presenting symptoms, but up to 40% women are asymptomatic. 1,2 Complications, such as uterine rupture and massive hemorrhage, may be lifethreatening and impact negatively on future fertility. Management options include methotrexate treatment, curettage, hysteroscopic resection, resection by laparotomy/laparoscopy and hysterectomy.…”

Section: Introductionmentioning

confidence: 99%