Cesarean scar pregnancy: A case report with surgical management after initially effective conservative treatment

Tsakiridis, Ioannis; Chatzikalogiannis, Ioannis; Mamopoulos, Apostolos; Dagklis, Themistoklis; Tsakmakidis, Georgios; Athanasiadis, Apostolos; Kalogiannidis, Ioannis

doi:10.1016/j.ijscr.2019.11.002

Cited by 5 publications

(1 citation statement)

References 18 publications

(24 reference statements)

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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

Ducu

Mihai³

et al. 2021

Diagnostics

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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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Section: Introductionmentioning

confidence: 99%

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

Bohîlțea

Ducu

Mihai³

et al. 2021

Diagnostics

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Investigation and management of abnormal uterine bleeding in reproductive-aged women: a descriptive review of national and international recommendations

Tsakiridis

Giouleka

Koutsouki

et al. 2022

The European Journal of Contraception & Reproductive Health

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Diagnosis and Management of Ectopic Pregnancy: A Comparative Review of Major National Guidelines

Tsakiridis¹,

Giouleka

Mamopoulos

et al. 2020

Obstetrical &Amp; Gynecological Survey

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Importance Ectopic pregnancies (EPs) represent a severe early pregnancy complication that is associated with increased risks of maternal morbidity and mortality. Over the years, there has been a significant reduction in the mortality from this complication by improving the diagnostic tools and the treatment options. Objective The aim of this study was to review and compare the recommendations from published guidelines on this potentially fatal condition. Evidence Acquisition A descriptive review of guidelines from the Royal College of Obstetricians and Gynaecologists, the Royal College of Physicians of Ireland, the Society of Obstetricians and Gynaecologists of Canada, the American College of Obstetricians and Gynecologists, and the National Institute for Health and Care Excellence on EP was carried out. Results All the guidelines point out the crucial role of sonography in the prompt diagnosis of EP and describe similar sonographic findings. There is a consensus on the indications and contraindications to the use of methotrexate, the post-treatment surveillance, and the criteria of expectant management. The indications for a surgical approach are not well established, although the Royal College of Obstetricians and Gynaecologists, the Royal College of Physicians of Ireland, the American College of Obstetricians and Gynecologists, and the National Institute for Health and Care Excellence agree that a laparoscopy is preferred to laparotomy for hemodynamically stable patients. The latter is considered a better option only in emergency conditions. However, there is controversy in the recommended methotrexate protocols and the evaluation of β-human chorionic gonadotrophin and progesterone levels. Conclusions It is of paramount importance to build consistent international protocols, so as to help clinicians all over the world diagnose EPs in the most timely and accurate way and subsequently treat them effectively as a nonurgent medical condition, with the intention to lower the mortality and morbidity rate. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After participating in this activity, the learner should be better able to explain all aspects of the diagnosis of tubal and nontubal EPs; identify the indications and contraindications to expectant, medical, or surgical management of EPs; and describe the appropriate management options for EPs.

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Cesarean scar pregnancy: A case report with surgical management after initially effective conservative treatment

Cited by 5 publications

References 18 publications

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

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

Investigation and management of abnormal uterine bleeding in reproductive-aged women: a descriptive review of national and international recommendations

Diagnosis and Management of Ectopic Pregnancy: A Comparative Review of Major National Guidelines

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