The trend of the distribution of ectopic pregnancy sites and the clinical characteristics of caesarean scar pregnancy

Abstract

Background Ectopic pregnancy is a life-threatening occurrence and is an important cause of pregnancy-related mortality. We launched the study to investigate the distribution and its variation trend of the ectopic pregnancy sites and the clinical characteristics of caesarean scar pregnancy, to provide information for further clinical practice. Methods A total of 3915 patients were included in our study to calculate the distribution of the implantation sites of ectopic pregnancies. Then, we performed a χ2 test for trend and calculated the quantity of each type of ectopic pregnancy during 2012–2015 and 2016–2019 to analyse the variation trend. Results (1) The proportion of each site of ectopic pregnancy was as follows: tubal pregnancy (84.70%), ovarian pregnancy (1.56%), caesarean scar pregnancy (8.63%), abdominal pregnancy (0.61%), cornual pregnancy (2.68%), cervical pregnancy (0.49%), heterotopic pregnancy (0.43%). (2) Through the χ2 test for trend, the ratio of caesarean scar pregnancy to ectopic pregnancy showed an upward trend (P = 0.005). From 2012 to 2015 and 2016–2019, the ratio of caesarean scar pregnancy to ectopic pregnancy increased from 5.74 to 11.81% (P < 0.001). (3) A total of 72.78% (246/338) caesarean scar pregnancy patients had one caesarean delivery, 25.15% (85/338) had two caesarean deliveries, and 2.07% (7/338) had three caesarean deliveries. A total of 80.18% (271/338) had aborted before. The most common clinical manifestations were amenorrhea (98.52%), abdominal pain (25.74%) and vaginal bleeding (67.76%), the most common sign was uterine enlargement (46.75%). Conclusion As the ratio of caesarean scar pregnancy increases, the caesarean delivery rate should be decreased to decrease the morbidity of caesarean scar pregnancy.

An update and review of nontubal ectopic pregnancy management

“…Cervical ectopic pregnancies are a rare diagnosis and represent only about 0.1–0.5% of all ectopic pregnancies [5 ▪ ,41]. There is significantly less literature regarding the diagnostic criteria for cervical ectopic pregnancy (CEP).…”

“…Since 2002, the cesarean section rate has increased significantly in the United States from 26.1% [3] to 31.8% [4] in 2022, and with this trend there has also been an increase in cesarean related morbidity. In a study published in 2022 of 3915 ectopic pregnancies, 85% were located within the fallopian tube, 8% cesarean scar pregnancy, 2.7% interstitial, 1.5% ovarian, 0.6% abdominal, and 0.5% cervical [5 ▪ ]. Although nontubal ectopic pregnancies remain the minority of ectopic gestations they appear to be increasing in prevalence and more physicians will encounter these difficult cases in their practice…”

Clinical and historical features of cesarean scar pregnancies in a tertiary hospital with a high rate of cesarean section: A case–control survey

“…5 Although this disease seems as an "emerging challenge," the studies conducted for CSP evaluations appear to be in their initial steps. [6][7][8][9][10] Of course CSP is an iatrogenic complication through prior cesarean section and better understanding of the risk factors may lead to a good prevention protocol. Also, early CSP diagnosis and termination is highly important to avoid serious complications.…”

Tissue concentration of vascular endothelial growth factor is not related to the depth of trophoblastic invasion in ampullary pregnancies—A pilot study

“…Ectopic pregnancy (EP) is an obstetric complication in which the fertilized ovum implants outside the intrauterine cavity ( Cunningham et al, 2022 ). The most common site of ectopic implantation is the fallopian tube (approximately 95% of cases), but other sites such as the ovaries and abdomen can be involved too ( Tang et al, 2022 ). Seventy percent of fallopian tube pregnancies are located in the ampullary segment ( Cunningham et al, 2022 ; Tang et al, 2022 ).…”

“…The most common site of ectopic implantation is the fallopian tube (approximately 95% of cases), but other sites such as the ovaries and abdomen can be involved too ( Tang et al, 2022 ). Seventy percent of fallopian tube pregnancies are located in the ampullary segment ( Cunningham et al, 2022 ; Tang et al, 2022 ). EP is the most common cause of maternal mortality in the first trimester of pregnancy, justifying its clinical relevance ( Creanga et al, 2017 ; Lisonkova et al, 2019 ).…”