Successful treatment of a recurrent Cesarean scar ectopic pregnancy by surgical repair of the uterine defect

Nagi, Jara Ben; Ofili-Yebovi, D.; Sawyer, E.; Aplin, John D.; Jurkovic, D.

doi:10.1002/uog.3843

Cited by 55 publications

(49 citation statements)

References 4 publications

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“…However, little is known about the outcome of subsequent pregnancies in women with rCSP. This particular case as described in our case series prove that women who experienced rCSP could carry a pregnancy to term despite previous reports showing poor outcomes of either rCSP or miscarriage following one CSP [13,18].…”

Section: Recurrent Csp Following One Cspcontrasting

confidence: 68%

“…In our unit, there was 1 rCSP observed in 9 pregnancies conceived after the first CSP. Therefore, it appeared that rCSP may not be due to a chance event; having one CSP is likely to predispose a woman to rCSP [13,16,[18][19][20][21]15]. However, little is known about the outcome of subsequent pregnancies in women with rCSP.…”

Section: Recurrent Csp Following One Cspmentioning

confidence: 99%

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Reproductive outcomes following cesarean scar pregnancy – a case series and review of the literature

Gao

Huang

Zhang

et al. 2016

European Journal of Obstetrics & Gynecology and Reproductiv

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Section: Recurrent Csp Following One Cspcontrasting

confidence: 68%

Section: Recurrent Csp Following One Cspmentioning

confidence: 99%

Reproductive outcomes following cesarean scar pregnancy – a case series and review of the literature

Gao

Huang

Zhang

et al. 2016

European Journal of Obstetrics & Gynecology and Reproductiv

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“…However, in all published cases, a hysterectomy with permanent loss of fertility as the result of a morbidly adherent placenta has been the end result. [24][25][26][27][28][29] In 2012, Sinha and Mishra 30 reported a patient with a cesarean scar pregnancy who continued the pregnancy and at 37 weeks underwent an elective cesarean delivery, which was complicated by a morbidly adherent placenta and massive postpartum hemorrhage and followed by a hysterectomy. The histologic findings from the placenta were consistent with placenta increta.…”

Section: Discussionmentioning

confidence: 99%

Cesarean Scar Pregnancies

Timor‐Tritsch

Khatib

Monteagudo

et al. 2015

J of Ultrasound Medicine

123

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Objectives To evaluate the management, clinical courses, and outcomes of cesarean scar pregnancies diagnosed in the first trimester. Methods We identified 60 cases of cesarean scar pregnancies diagnosed between 5 and 14 weeks. Group A contained 48 patients with fetal/embryonic cardiac activity; group B comprised 12 patients without cardiac activity; and group C included 11 patients with cardiac activity who chose expectant management. Results Five of the 48 patients (10.4%) in group A were successfully treated for vaginal bleeding. Thirty‐three (68.7%) received methotrexate injections, and all had full resolution. Three (6.3%) required uterine artery embolization for late‐developing arteriovenous malformations. Ten of the 12 patients (83.3%) in group B were managed expectantly and had full recovery. Two of the 10 (20.0%) had arteriovenous malformations; 1 had unsuccessful uterine artery embolization followed by a hysterectomy, and the second requested a hysterectomy. Ten of the 11 patients (90.9%) in group C continued the pregnancies. One declined local injection. Four of the 10 (40.0%) delivered live offspring by successive elective cesarean deliveries. Three (30.0%) had hysterectomies for placenta percreta, and 1 did not have a hysterectomy after delivery. Five (50%) had second‐trimester complications, all leading to hysterectomies. Of the 60 patients, 20 (33.3%) had serious complications: 5 had arteriovenous malformations; 4 had uterine artery embolization; and 11 had hysterectomies. Conclusions A cesarean scar pregnancy is a serious complication for patients who have had cesarean deliveries. Counseling, treatment, and follow‐up are challenging for patients and caregivers. However, emerging data from different management approaches confirm that a cesarean scar pregnancy may progress and result in a live neonate at the expense of further fertility. This study confirmed that expectant management of a cesarean scar pregnancy is associated with a high risk of hysterectomy due to morbidly adherent placenta.

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“…Although this study showed that the operative time in group B was longer than group A, there was no statistically significant difference between the two groups with respect to other characteristics. Furthermore, surgery completely removes the pregnancy and repairs the scar defect, which will cause a predisposition to another ectopic implantation [30,31]. Godin et al [5 ]and Deans and Abbott [32] also demonstrated that strengthening the uterine wall of the scar area is necessary, especially in those patients who desire fertility.…”

Section: Discussionmentioning

confidence: 99%

Management of Caesarean Scar Pregnancies Using an Intrauterine or Abdominal Approach Based on the Myometrial Thickness between the Gestational Mass and the Bladder Wall

Shao

et al. 2013

Gynecol Obstet Invest

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Aim: To describe our experience with various interventions for caesarean scar pregnancies (CSPs) based on the myometrial thickness between the gestational mass and the bladder. Methods: All patients were initially administered methotrexate. Then, the appropriate therapies hysteroscopy alone or combined with uterine artery embolization (group A) and direct laparoscopy alone or combined with laparoscopic uterine artery occlusion (group B) was selected based on the myometrial thickness between the gestational mass and the bladder. Results: The uteri of all 53 patients with CSPs were conserved; no conversion to laparotomy or blood transfusion was required. Uterine rupture occurred in one case during surgery in group A. The operative time in group B was longer than group A (42 ± 18 vs. 80 ± 33 min; p = 0.022). The two groups were also similar with respect to other characteristics (p > 0.05). Conclusion: Myometrial thickness should be considered during the management of CSPs. Surgical approaches in the treatment of CSPs using 2-mm boundaries may yield an optimal clinical outcome.

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Successful treatment of a recurrent Cesarean scar ectopic pregnancy by surgical repair of the uterine defect

Cited by 55 publications

References 4 publications

Reproductive outcomes following cesarean scar pregnancy – a case series and review of the literature

Reproductive outcomes following cesarean scar pregnancy – a case series and review of the literature

Cesarean Scar Pregnancies

Management of Caesarean Scar Pregnancies Using an Intrauterine or Abdominal Approach Based on the Myometrial Thickness between the Gestational Mass and the Bladder Wall

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