Outcome of cesarean scar pregnancy according to gestational age at diagnosis: A systematic review and meta-analysis

Timor‐Tritsch, Ilan E.; Buca, Danilo; Mascio, Daniele Di; Calì, Giuseppe; D’Amico, Alice; Monteagudo, Ana; Tinari, Sara; Morlando, Maddalena; Nappi, Luigi; Greco, Pantaleo; Rizzo, Giuseppe; Liberati, Marco; Jose-Palacios-Jaraquemada,; D’Antonio, F.

doi:10.1016/j.ejogrb.2020.11.036

Cited by 39 publications

(35 citation statements)

References 63 publications

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“…The diagnostic of the CSP was performed by ultrasound means. Following the results obtained by Timor-Tritsch et al [ 5 ] we measured the residual myometrial layer between the gestational sac and bladder and established the presence or absence of fetal heartbeat as well as the presence/absence of rich vascular pattern in the placenta. Our results are presented in Table 2 .…”

Section: Resultsmentioning

confidence: 94%

“…There are two types of CSP. The diagnosis of CSP Type 1 (on the scar) vs. type 2 (in the niche) is defined if >50% of the gestational sac protrudes towards the uterine cavity/cervical canal, whereas type 2 CSP is defined by the trophoblastic implantation into a deficient or dehiscent scar and the protrusion of the gestational sac is ≤50% [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Since the fertility is completely lost, this procedure is reserved only for the most dire cases. According to Timor-Tritsch et al [ 5 ] this happens in 3.7% of CSP cases diagnosed before 9 weeks of pregnancy and 16.3% of cases diagnosed in the late first trimester.…”

Section: Introductionmentioning

confidence: 99%

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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: Resultsmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

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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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“…CSP occur with an overall incidence of 1: 1800-1: 2216 pregnancies [17]. Even in earlypregnancy, CSP treatment can be associated with severe hemorrhage [18]. In most cases, CSP results in morbidly-adhaerent placenta like placenta accreta, increta or percreta [19].…”

Section: Pregnant Womenmentioning

confidence: 99%

Prevention of Cesarean Scar Defects: What Is Possible?

Litzka¹,

Schnabel²,

Solano³

et al. 2021

Current Topics in Caesarean Section

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Defect healing of the uterotomy at ceasarean section (CS) results in a morphological und probably functional disruption of the anterior uterine wall. Clinical sequelae concern subsequent pregnancies with a broad range of complications before and during pregnancy as well as at birth. In the following chapter, we provide an overview about the definition, diagnosis, symptoms and pathogenetical mechanisms of CS scar defects. Keeping in mind the pathogenesis allows to introduce preventative approaches.

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“…Caesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy that can have potentially catastrophic consequences, including massive bleeding, uterine rupture and even life-threatening events. Compared with placenta implantation alone without uterine scarring, in CSP, implantation in the scar tissue that is de cient in myometrium results in poor contractility, which may carry additional risks and further aggravate haemorrhage [1][2][3]. CSP also has been linked with the risk of placenta accreta spectrum (PAS) [4].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopy or Laparotomy for High-risk Caesarean Scar Pregnancy: A Retrospective Study

Zhou

Wang

et al. 2021

Preprint

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Background: Caesarean scar pregnancy (CSP) can have catastrophic consequences. A standardized diagnosis and treatment for CSP are still lacking. The currently available treatment methods are confusing, and at least 10 different treatment measures exist. The aim of this study was to compare the outcomes of with laparotomy or laparoscopy in the treatment of high-risk CSP. Methods: We reviewed 935 patients with CSP from 1 January 2013 and 31 December 2018. A total of 278 patients were included in the study, of whom 121 were treated with laparoscopy and 157 were treated with laparotomy.Results: We compared and analysed the characteristics of the laparoscopic and open surgeries in the treatment of high-risk CSP and the advantages and disadvantages of different methods of vascular pretreatment. Intraoperative bleeding, transfusion rate, total days of hospitalization and postoperative hospital stay were better in laparoscopy than in laparotomy (P < 0.05). There was no difference in the factors (β-HCG decrease, reoperation and tissue residues) closely related to the success of the surgery in the two groups. Furthermore, we pretreated blood vessels differently before the operation in some patients. Tissue residue, reoperation and intraoperative blood transfusion rates in patients with temporary vascular occlusion were better than in patients with permanent vascular occlusion. Conclusions: This study revealed that laparoscopic surgery is superior to laparotomic surgery in the treatment of high-risk CSP. Patients benefited from temporary arterial occlusion in both groups. Temporary arterial occlusion under laparoscopic surgery may be the best treatment for high-risk CSP.

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Outcome of cesarean scar pregnancy according to gestational age at diagnosis: A systematic review and meta-analysis

Cited by 39 publications

References 63 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

Prevention of Cesarean Scar Defects: What Is Possible?

Laparoscopy or Laparotomy for High-risk Caesarean Scar Pregnancy: A Retrospective Study

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