Cesarean scar pregnancy: uterine artery embolization combined with a hysterectomy at 13 weeks’ gestation – a case report and review of the literature

Kwaśniewska, Anna; Stupak, Aleksandra; Krzyżanowski, Arkadiusz; Pietura, Radosław; Kotarski, Jan

doi:10.17772/gp/1890

Cited by 7 publications

(14 citation statements)

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“…Previous studies have shown the following advantages of UAE in treating uterine CSP [ 23 , 24 ]. (1) Embolizing the uterine artery can directly block the uterine blood circulation, cause ischemia and hypoxia in local lesions, and deprive embryos of blood supply to achieve mechanical necrosis.…”

Section: Discussionmentioning

confidence: 99%

Clinical Efficacy and Safety of Uterine Artery Embolization (UAE) versus Laparoscopic Cesarean Scar Pregnancy Debridement Surgery (LCSPDS) in Treatment of Cesarean Scar Pregnancy

Guo

Zhang

et al. 2018

Med Sci Monit

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BackgroundThe present study aimed to compare the clinical efficacy and safety of uterine artery embolization (UAE) vs. laparoscopic cesarean scar pregnancy debridement surgery (LCSPDS) in the treatment of patients with cesarean scar pregnancy (CSP).Material/MethodsA retrospective analysis was performed on 87 CSP patients from March 2012 to February 2017. For the included 87 cases, 51 were treated with UAE and 36 were treated with LCSPDS. The operation success rate, intraoperative blood loss, operation time, length of hospital stay, perioperative complications, and β-HCG level were compared.ResultsFor the UAE group, 41 patients underwent successful surgeries (80.4% success rate), and 36 cases in the LCSPDS group were successfully treated, with no case of perioperative death. In the UAE group, the operation time, intraoperative blood loss, and length of hospital stay were 82.23±45.21 min, 112.58±68.54 mL, and 12.56±3.03 days, respectively. In the LCSPDS group, the operation time, intraoperative blood loss, and length of hospital stay were 85.45±30.02 min, 108.56±54.12 mL and 7.65±2.48 days, respectively. The length of hospital stay for the UAE group was significantly longer than in the LCSPDS group (P<0.05).ConclusionsUAE and LCSPDS each have their own advantages and disadvantages in treating CSP. Thus, appropriate individualized surgical programs based on specific patient circumstances are needed to avoid indiscriminately performing complete uterine cavity curettage.

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Section: Discussionmentioning

confidence: 99%

Clinical Efficacy and Safety of Uterine Artery Embolization (UAE) versus Laparoscopic Cesarean Scar Pregnancy Debridement Surgery (LCSPDS) in Treatment of Cesarean Scar Pregnancy

Guo

Zhang

et al. 2018

Med Sci Monit

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“…The US scan revealed the gestational sac in the area of the scar from the previous cesarean section, and a single embryo with heart activity (Figure 1). 5. the pathologies of the adnexa should be excluded, and there should be no detection of fluid in the Douglas pouch unless in the case of a massive hemorrhage or rupture of the uterus [5].…”

Section: Casementioning

confidence: 99%

“…A previous CS increases the threat of pathological placentation [5]. Therefore, advances in obstetrics and the biology of the wound after a hysterotomy are of interest for all obstetricians.…”

Section: Introductionmentioning

confidence: 99%

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Scar Tissue after a Cesarean Section—The Management of Different Complications in Pregnant Women

Stupak

Kondracka

Fronczek

et al. 2021

IJERPH

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The definition of a cesarean scar pregnancy (CSP) is the localization of the gestational sac (GS) in the cicatrix tissue, which is created in the front wall of the uterus after a previous cesarean section (CS). The worldwide prevalence of CSP has been growing rapidly. However, there are no general recommendations regarding prophylaxis and treatment of the abnormalities of the anterior wall of the uterus discovered in a non-pregnant myometrium, or how to deal with existing cases of CSP. We present the latest knowledge, a holistic approach to the biology, histology, imaging, and management concerning post-CS scars based on our cases, which were treated in the Department of Pregnancy and Pathology of Pregnancy in the Medical University of Lublin, Poland. In our study, we present images of tissue samples of areas with a cicatrix in the uterus, and ultrasound and MRI images of CSP. We discuss the advances in the biology of the post-CS scar tissue, the prevention techniques used to repair the scar defect (niche) before the pregnancy, and the treatment of different complications of CSP, such as the rupture of the gravid uterus or the dehiscence of the myometrium.

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“…The first detection of a 7-week cesarean scar pregnancy on transvaginal US occurred in 1990 (11) . Studies indicate that CSP can be detected between day 33 and 94 of pregnancy (12) . Even at present, despite advanced technology, misdiagnoses are common.…”

Section: Diagnosismentioning

confidence: 99%

Cesarean scar pregnancy – a new challenge for obstetricians

Pędraszewski¹,

Wlaźlak

Panek³

et al. 2018

J Ultrason

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Diagnosis and treatment of ectopic cesarean scar pregnancy has become a challenge for contemporary obstetrics. With an increase in the number of pregnancies concluded with a cesarean section and with the development of transvaginal ultrasonography, the frequency of cesarean scar pregnancy diagnoses has increased as well. The aim of the study is to evaluate various diagnostic methods (ultrasonography in particular) and analyze effective treatment methods for cesarean scar pregnancy. An ultrasound scan, Doppler examination and magnetic resonance imaging are all useful in early detection of asymptomatic cesarean scar pregnancy, thus enabling effective treatment and preservation of fertility. Dilatation and curettage is not recommended as it carries significant risk of bleeding and very high risk of hysterectomy and fertility loss. Systemic methotrexate treatment should not be applied on the routine basis due to its low efficacy, high risk of fertility loss and adverse effects. Local methotrexate therapy (under ultrasound or hysteroscopy guidance) should be considered a perfect management method as it offers fertility preservation in asymptomatic pregnant patients without concomitant hemodynamic disorders. Synchronous usage of several treatment methods is an effective way to manage cesarean scar pregnancy. The combination of local methotrexate with simultaneous aspiration of gestational tissues under ultrasound or hysteroscopy guidance seems optimal. Subsequently, the remaining gestational tissues can be removed hysteroscopically in combination with vascular coagulation at the implantation site. In more advanced cases, local methotrexate treatment should be considered followed by laparoscopic or laparotomic wedge resection with subsequent surgical correction of the cesarean section scar.

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Cesarean scar pregnancy: uterine artery embolization combined with a hysterectomy at 13 weeks’ gestation – a case report and review of the literature

Cited by 7 publications

References 0 publications

Clinical Efficacy and Safety of Uterine Artery Embolization (UAE) versus Laparoscopic Cesarean Scar Pregnancy Debridement Surgery (LCSPDS) in Treatment of Cesarean Scar Pregnancy

Clinical Efficacy and Safety of Uterine Artery Embolization (UAE) versus Laparoscopic Cesarean Scar Pregnancy Debridement Surgery (LCSPDS) in Treatment of Cesarean Scar Pregnancy

Scar Tissue after a Cesarean Section—The Management of Different Complications in Pregnant Women

Cesarean scar pregnancy – a new challenge for obstetricians

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