Successful Conservative Treatment of a Cesarean Scar Pregnancy with Uterine Artery Embolization

Sugawara, Junichi; Senoo, Masato; Chisaka, Hiroshi; Yaegashi, Nobuo; Okamura, Koji

doi:10.1620/tjem.206.261

Cited by 82 publications

(75 citation statements)

References 13 publications

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“…In addition, we expected that the bleeding risk after secondary procedure, such as uterine curettage, would be reduced by embolization. The effi cacy of uterine artery embolization before the management of Cesarean scar pregnancy was already reported in previous studies [5,12]. Sugawara et al [5] reported a case of scar pregnancy treated with selective transarterial embolization in combination with subsequent dilatation and curettage and local or systemic injections of MTX.…”

Section: Discussionmentioning

confidence: 76%

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Successful conservative management of a viable Cesarean scar pregnancy: A case report

Lee

Choe

et al. 2012

Korean J Obstet Gynecol

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Cesarean scar pregnancy is the one of the rarest forms of ectopic pregnancy and is associated with severe complications, such as uncontrollable bleeding and uterine rupture. However optimal treatment has not been established. We present here a case of ectopic pregnancy in the previous Cesarean scar treated successfully by uterine artery embolization in combination with subsequent intra-cardiac potassium chloride and intra-sac methotrexate injection without surgical or invasive intervention at 9+3 weeks' gestational age. Th is is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Keywords Copyright © 2012. Korean Society of Obstetrics and GynecologyCesarean scar pregnancy is a rare form of ectopic pregnancy implanted in the myometrium at the site of a previous Cesarean section scar [1,2]. These conditions are challenging to diagnose and have higher risk of bleeding and uterine rupture [3,4]. Due to the severity of complications and possibility of hysterectomy, early diagnosis is critical [5]. However, there is still no standard treatment modality. We report here a case of viable Cesarean scar pregnancy successfully treated with uterine artery embolization followed by local injection of potassium chloride (KCl) and methotrexate (MTX) under sonographic guidance at 9+3 weeks' gestational age which was advanced compared with those of previous reported cases. Case ReportA 34-year-old woman, gravida 2 para 1, visited outpatient clinic in Seoul National University Hospital for suspected Cesarean scar pregnancy. She had been naturally pregnant and underwent Cesarean delivery due to placenta previa on 2004. The next pregnancy was on December, 2006. But she was diagnosed with hydatidiform mole and treated with curettage and systemic methotrexate injection. After 1 year of treatment and follow-up, she was diagnosed with a cure. After that, she was failed to get pregnant during 2 years and underwent infertility examination. On hysterosalpingogram, right hydrosalpinx was noted and pelviscopic right salpingectomy was done on 2009. She underwent 3 times of in vitro fertilization cycle which were all failed. And then, she got taken thawing embryo transfer on 5, November, 2010 and conceived successfully. The β-subunit of serum human chorionic gonadotropin (β-hCG) values had been elevated as in normal pregnancy, and there were no signs or symptoms of an ectopic pregnancy. At eight weeks' gestational age, the gestational sac was noted to be located into the previous Cesarean scar with normal fetal heart beat and appropriate crown-rump length. On December 17, she was referred to our hospital. The levels of CASE REPORT Korean J Obstet Gynecol 2012;55(4):274-277 http://dx

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Section: Discussionmentioning

confidence: 76%

“…These conditions are challenging to diagnose and have higher risk of bleeding and uterine rupture [3,4]. Due to the severity of complications and possibility of hysterectomy, early diagnosis is critical [5]. However, there is still no standard treatment modality.…”

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confidence: 99%

Successful conservative management of a viable Cesarean scar pregnancy: A case report

Lee

Choe

et al. 2012

Korean J Obstet Gynecol

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“…Patients who have experienced different cesarean segments give off an impression of being at expanded hazard for in-scar implantation of the ensuing pregnancy on account of expanded scar surface zone [4,8,9]. With the coming of transvaginal sonography and with the utilization of saline imbuement, it is conceivable to survey postcaesarean area uterine divider respectability even in the nonpregnant state [4,[10][11][12]. Cesarean segment scar deformity is distinguished by the nearness of liquid inside the entry point site [12] or any filling imperfection, which is characterized as a triangular anechoic structure at the assumed site of the scar.…”

Section: Discussionmentioning

confidence: 99%

Case Report on Labor and Delivery While Placenta Presence in Caesarian

John¹

2017

Med Rep Case Stud

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Among the 65,000 live births in the Ukraine, 3 result in maternal demise. Some of these passings happen taking after difficulties related with placenta previa, which is show in roughly 1 in 200 pregnancies. Placenta previa happen when the placenta is situated in the lower some portion of the uterus, near or including the cervical opening. Commonly connected with or suspected in the nearness of placenta previa is the turmoil of placenta accreta, which is a type of unusual placentation and happens when the placenta imbeds defectively into the mass of the myometrium. The event rate of placenta accreta is around 1 in each 2,500 pregnancies. Placenta previa and placenta accreta are related with expanded maternal discharge and coming about expanded maternal mortality and morbidity. When the rate of cesarean conveyance expands, a relating increment in the event rate of placenta previa and placenta accreta has been watched. The rate of cesarean conveyance in the joined States is 31.1% and is at a record-breaking high. The expanded rate of cesarean conveyance is multifactorial. The number of essential cesarean conveyances being performed has expanded. In the interim, the quantity of vaginal births after cesarean conveyance has diminished. This diminished number has added to an expanded rate of rehashed cesarean conveyance. The reason for this case report is to survey the administration of a patient conceded for elective cesarean conveyance with known placenta previa and suspected placenta accreta. The case report will be trailed by a general talk identified with the administration of obstetric patients with placenta previa and placenta.

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“…If the pregnant reported no clinical evidence of suffering, such us bleeding or abdominal pain, and the diagnosis is made at an early stage, we can consider a conservative management with systemic or local injection of methotrexate, potassium chloride, and hyperosmolar glucose [17,21,[27][28][29]. However, recent reports evidenced that the cases treated with local or systemic methotrexate, often required laparotomy due to massive hemorrhage [30]. Lee et al [31], in a retrospective review, enlisted nine women diagnosed with ectopic pregnancy on previous cesarean section scar; seven of them underwent laparoscopic treatment, thus, the gestational sac was removed by laparoscopy without converting to laparotomy, and the scar defect was repaired by intracorporeal sutures.…”

Section: Discussionmentioning

confidence: 99%

Cervico-isthmic pregnancy developing within the scar of a previous cesarean section: a case report

et al. 2009

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Successful Conservative Treatment of a Cesarean Scar Pregnancy with Uterine Artery Embolization

Cited by 82 publications

References 13 publications

Successful conservative management of a viable Cesarean scar pregnancy: A case report

Successful conservative management of a viable Cesarean scar pregnancy: A case report

Case Report on Labor and Delivery While Placenta Presence in Caesarian

Cervico-isthmic pregnancy developing within the scar of a previous cesarean section: a case report

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