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DOI: 10.1055/s-0041-1728781
A Scary Complication: Single-center Study on Management and Outcome of Cesarean Scar Pregnancy
Autoren
Abstract
A cesarean scar pregnancy (CSP) is a scary and life-threatening complication of cesarean section (CS). Nevertheless, the incidence of CS is constantly growing. The CSP incidence is 0,15% of pregnancies after CS which represents 6,1% of all ectopic pregnancies in women with condition after CS. Therefore, it should be more present in the clinical daily routine. From mild nonspecific symptoms to hypovolemic shock, diagnosis and therapy must be performed quickly. With the progressive growth of the scar pregnancy, a uterine rupture involves the risk of severe bleeding, and an emergency hysterectomy could be necessary. Prolongation of pregnancy has been successful only in a few cases. We report 11 cases from our hospital in the past 10 years. In the discussion, treatment options of this complication with an increasing incidence, which is associated with serious morbidity and mortality, are presented based on the current literature. Treatment options include drug therapy, but also surgical or combined procedures with radiological intervention.
Keywords
scar pregnancy - therapy scar pregnancy - ectopic pregnancies - cesarean section - hysterectomyPublikationsverlauf
Eingereicht: 22. August 2020
Angenommen: 06. Januar 2021
Artikel online veröffentlicht:
12. Mai 2021
© 2021. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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References
- 1 Birch Petersen K, Hoffmann E, Rifbjerg Larsen C, Svarre Nielsen H. Cesarean scar pregnancy: a systematic review of treatment studies. Fertil Steril 2016; 105 (04) 958-967
- 2 30,5% der Krankenhausentbindungen per Kaiserschnitt im Jahr 2017 [Internet]. Statistisches Bundesamt. 2018 [cited 2020 Sep 18]. Available from: https://www.destatis.de/DE/Presse/Pressemitteilungen/2018/09/PD18_349_231.html
- 3 Rudey EL, Leal MDC, Rego G. Cesarean section rates in Brazil: Trend analysis using the Robson classification system. Medicine (Baltimore) 2020; 99 (17) e19880
- 4 Calì G, Timor-Tritsch IE, Palacios-Jaraquemada J, Monteagudo A, Buca D, Forlani F. et al. Outcome of Cesarean scar pregnancy managed expectantly: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2018; 51 (02) 169-175
- 5 Doroszewska K, Milewicz T, Bereza T, Horbaczewska A, Komenda J, Kłosowicz E. et al. Cesarean scar pregnancy - various methods of treatment. Folia Med Cracov 2019; 59 (02) 5-14
- 6 Larsen JV, Solomon MH. Pregnancy in a uterine scar sacculus--an unusual cause of postabortal haemorrhage. A case report. S Afr Med J 1978; 53 (04) 142-143
- 7 Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol 2006; 107 (06) 1373-1381
- 8 Seow KM, Huang LW, Lin YH, Lin MYS, Tsai YL, Hwang JL. Cesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol 2004; 23 (03) 247-253
- 9 Ash A, Smith A, Maxwell D. Caesarean scar pregnancy. BJOG 2007; 114 (03) 253-263
- 10 Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson CJ. First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment Cesarean section scar. Ultrasound Obstet Gynecol 2003; 21 (03) 220-227
- 11 Ding W, Zhang X, Qu P. An efficient conservative treatment option for cervical pregnancy: transcatheter intra-arterial methotrexate infusion combined with uterine artery embolization followed by curettage. Med Sci Monit 2019; 25: 1558-1565
- 12 Morlando M, Buca D, Timor-Tritsch I. et al. Reproductive outcome after cesarean scar pregnancy: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2020; 99 (10) 1278-1289
- 13 D'Antonio F, Timor-Tritsch IE, Palacios-Jaraquemada J, Monteagudo A, Buca D, Forlani F. et al. First-trimester detection of abnormally invasive placenta in high-risk women: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2018; 51 (02) 176-183
- 14 Gonzalez N, Tulandi T. Cesarean scar pregnancy: a systematic review. J Minim Invasive Gynecol 2017; 24 (05) 731-738
- 15 Vial Y, Petignat P, Hohlfeld P. Pregnancy in a cesarean scar. Ultrasound Obstet Gynecol 2000; 16 (06) 592-593
- 16 Herman A, Weinraub Z, Avrech O, Maymon R, Ron-El R, Bukovsky Y. Follow up and outcome of isthmic pregnancy located in a previous caesarean section scar. Br J Obstet Gynaecol 1995; 102 (10) 839-841
- 17 Timor-Tritsch IE, Khatib N, Monteagudo A, Ramos J, Berg R, Kovács S. Cesarean scar pregnancies: experience of 60 cases. J Ultrasound Med 2015; 34 (04) 601-610
- 18 Cali G, Forlani F, Timor-Tritsch IE, Palacios-Jaraquemada J, Minneci G, D'Antonio F. Natural history of Cesarean scar pregnancy on prenatal ultrasound: the crossover sign. Ultrasound Obstet Gynecol 2017; 50 (01) 100-104
- 19 Kaelin Agten A, Cali G, Monteagudo A, Oviedo J, Ramos J, Timor-Tritsch I. The clinical outcome of cesarean scar pregnancies implanted “on the scar” versus “in the niche”. Am J Obstet Gynecol 2017; 216 (05) 510.e1-510.e6
- 20 Kim SY, Yoon SR, Kim MJ, Chung JH, Kim MY, Lee SW. Cesarean scar pregnancy; Diagnosis and management between 2003 and 2015 in a single center. Taiwan J Obstet Gynecol 2018; 57 (05) 688-691
- 21 Vo TM, Van T, Nguyen L, Tran Q. Management of cesarean scar pregnancy among Vietnamese women. Gynecol Minim Invasive Ther 2019; 8 (01) 12-18
- 22 Timor-Tritsch IE, Monteagudo A, Bennett TA, Foley C, Ramos J, Kaelin Agten A. A new minimally invasive treatment for cesarean scar pregnancy and cervical pregnancy. Am J Obstet Gynecol 2016; 215 (03) 351.e1-351.e8
- 23 Ravhon A, Ben-Chetrit A, Rabinowitz R, Neuman M, Beller U. Successful methotrexate treatment of a viable pregnancy within a thin uterine scar. Br J Obstet Gynaecol 1997; 104 (05) 628-629
- 24 Wang S, Beejadhursing R, Ma X, Li Y. Management of Caesarean scar pregnancy with or without methotrexate before curettage: human chorionic gonadotropin trends and patient outcomes. BMC Pregnancy Childbirth 2018; 18 (01) 289
- 25 Lai YM, Lee JD, Lee CL, Chen TC, Soong YK. An ectopic pregnancy embedded in the myometrium of a previous cesarean section scar. Acta Obstet Gynecol Scand 1995; 74 (07) 573-576
- 26 Xiao Z, Cheng D, Chen J, Yang J, Xu W, Xie Q. The effects of methotrexate and uterine arterial embolization in patients with cesarean scar pregnancy: A retrospective case-control study. Medicine (Baltimore) 2019; 98 (11) e14913
- 27 Lee CL, Wang CJ, Chao A, Yen CF, Soong YK. Laparoscopic management of an ectopic pregnancy in a previous Caesarean section scar. Hum Reprod 1999; 14 (05) 1234-1236
- 28 He Y, Wu X, Zhu Q, Wu X, Feng L, Wu X. et al. Combined laparoscopy and hysteroscopy vs. uterine curettage in the uterine artery embolization-based management of cesarean scar pregnancy: a retrospective cohort study. BMC Womens Health 2014; 14: 116
- 29 Wang DB, Chen YH, Zhang ZF, Chen P, Liu K-R, Li Y. et al. Evaluation of the transvaginal resection of low-segment cesarean scar ectopic pregnancies. Fertil Steril 2014; 101 (02) 602-606