Conservative Management of Cesarean Scar Pregnancy: A Case Report and Literature Review

Sánchez‐Prieto, Manuel; Puy, María Jesús; Barbany, Núria; Graupera, B.; Pascual, M.; Barri-Soldevila, Pere

doi:10.1155/2022/1793943

Cited by 4 publications

(4 citation statements)

References 27 publications

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“…The possibility of scar dehiscence while waiting for methotrexate to work in twin pregnancy was not acceptable. Methotrexate injection or potassium chloride injection in the gestational sac had its own risks [5][6][7].…”

Section: Discussionmentioning

confidence: 99%

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Conservative surgical management of a heterotopic scar pregnancy: A case report

Desai,

Mutatkar

2023

J Case Rep Images Obstet Gynecol

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Introduction: The cesarean scar pregnancy is on rise and the objective of this case study is to highlight a different, bold but conservative approach to an unusual challenging case of eight weeks heterotopic cesarean scar pregnancy, which was threatening to rupture. Case Report: A 31-year-old G3P2L1 previous two cesarean sections presented with lower abdominal pain and bleeding. She was hemodynamically stable, and ultrasonography (USG) and magnetic resonance imaging (MRI) revealed heterotopic pregnancy, eight weeks (gestational sacs > 32 mm) intrauterine and caesarean scar pregnancy, which was threatening to rupture. Since the scar pregnancy was large, BHcG was > 200,000 iu, there was evidence of imminent scar dehiscence; and she was stable and had good blood parameters. The authors decided to take cautious but bold decision of suction evacuation under USG guidance, following the uterine artery embolism. The procedure was smooth and lower segment scar sacculus bleeding was controlled by compression with help of Foley’s balloons inside uterine cavity as well as in bladder. There was no evidence of extrauterine bleeding. She made a good post-operative recovery. Follow-ups consisted of serial BHcG and USG to monitor the regress. Conclusion: This case study implies that cesarean scar pregnancy, even with imminent scar dehiscence can be managed by USG-guided suction evacuation by experienced hands. Prior uterine artery embolization (UAE) added the safety of bleeding control. This case also emphasizes the importance of a patient monitoring and relying on failing BHcG, and a symptom free patient; and not on mass in CS scar alone which was slow to resolve.

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Section: Discussionmentioning

confidence: 99%

“…Since the patient was hemodynamically stable, had good blood parameters; a decision of surgical suction evacuation under USG guidance after uterine artery embolization was taken. The patient was properly counseled with due consent of laparotomy and hysterectomy with possible bladder injury [6,8].…”

Section: Discussionmentioning

confidence: 99%

Conservative surgical management of a heterotopic scar pregnancy: A case report

Desai,

Mutatkar

2023

J Case Rep Images Obstet Gynecol

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“…Once the diagnosis is delayed, a CSP can easily cause placenta implantation, which may result in massive hemorrhage and even hemorrhagic shock. Therefore, optimal prognosis can only be achieved through early diagnosis and treatment (15).…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy analysis of laparoscopic uterine artery pre-ligation combined with hysteroscopic curettage in the treatment of type II cesarean scar pregnancy

Teng

Gao

et al. 2023

Front. Med.

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ObjectiveTo explore and evaluate the clinical therapeutic effect of laparoscopic uterine artery pre-ligation combined with hysteroscopic curettage in the treatment of type II cesarean scar pregnancy.MethodsThis study analyzed the clinical data of patients with cesarean scar pregnancy (CSP) in the Maternal and Child Health Hospital of Hubei Province from 2018 to 2022. A total of 134 patients with type II cesarean section were enrolled, out of which 78 patients were included in the final analysis. Treatment included either uterine artery embolization (UAE) combined with hysteroscopic curettage (n = 37 patients) or laparoscopic uterine artery pre-ligation (LUAP) combined with hysteroscopic curettage (n = 41 patients). The demographic and clinical characteristics of these two groups were recorded, and their short- and long-term complications on follow-up were compared. For patients with subsequent fertility requirements, we followed up these patients for 2 years after surgery, then collected and analyzed the compared subsequent pregnancy outcome.ResultsWe found no significant discrepancies in the success rate of operation, length of hospital stay, and intraoperative blood loss between the two different operation modes. The cost of LUAP was significantly lower than that of UAE. Furthermore, the incidence of short-term postoperative complications such as fever and pelvic pain was lower in patients treated with LUAP than in those treated with UAE. In terms of long-term postoperative complications, the recovery time for menstruation in the LUAP group (49.81 ± 11.47) was earlier than that in the UAE group (34.90 ± 7.41) (p < 0.05). Additionally, 4.9% of patients in the LUAP group had decreased menstrual flow, while 59% of patients in the UAE group had a marked decrease in menstrual flow, and the incidence and severity of intrauterine adhesions were significantly lower in the LUAP group than in the UAE group(p < 0.05). Consistent with the aforementioned observations, patients treated with LUAP had better postoperative re-pregnancy outcomes than those treated with UAE.ConclusionsBased on the findings, LUAP combined with hysteroscopic curettage is a safe and effective surgical scheme for the treatment of type II CSPs. In addition, compared with UAE, LUAP is associated with a lower surgical cost, fewer short and long-term complications, and better postoperative pregnancy outcomes. Thus, it should be widely applied in patients with type II CSPs.

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“…There has been a dramatic increase in caesarean section rates and the number of women enduring numerous caesarean sections over the past several decades [1] . So, a rise in the number of complications has followed, consequently, isthmocele (Niche), a caesarean scar deformity, has emerged as a clinical pathology [2] .…”

Section: Introductionmentioning

confidence: 99%

Uterine Niche and Secondary Infertility: Agreement in Diagnosis Using Hysterosalpingography vs. Hydrosonography

Etman

Azeem

El-Samie

et al. 2022

Evidence Based Women's Health Journal

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Objectives: To compare the accuracy of hydrosonography and hysterosalpingography in diagnosis of niche and to evaluate the correlation between niche and sub-infertility. Study Design: A prospective observational cross-sectional comparative study Patients and Methods: The study was carried out on 50 women underwent at least one caesarean section with unexplained secondary infertility presented at the outpatient obstetric clinic at Fayoum university hospital. Assessment of uterine scar in each woman was performed using 2D transvaginal with Saline Infusion hydrosonography (SHG) followed by hysterosalpingography. Results:The prevalence of niche among our studied women was (62%, 31 cases) as diagnosed by Hydrosonography, while by Hysterosalpingography, the prevalence was (56%, 28 cases). Hydrosonography and hysterosalpingography showed strong substantial agreement regarding niche with kappa (κ) 0.712. Using hysterosalpingography can diagnose post-CS niche as compared with hydrosonography with 83.9% sensitivity 89.5% specificity, 92.9% PPV, 77.3% NPP and 86% accuracy. Conclusions: We detected a strong substantial agreement between hydrosonography and hysterosalpingography in diagnosis of niche.

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Conservative Management of Cesarean Scar Pregnancy: A Case Report and Literature Review

Cited by 4 publications

References 27 publications

Conservative surgical management of a heterotopic scar pregnancy: A case report

Conservative surgical management of a heterotopic scar pregnancy: A case report

Clinical efficacy analysis of laparoscopic uterine artery pre-ligation combined with hysteroscopic curettage in the treatment of type II cesarean scar pregnancy

Uterine Niche and Secondary Infertility: Agreement in Diagnosis Using Hysterosalpingography vs. Hydrosonography

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