Molar Pregnancy in Cesarean Section Scar: A Case Report and Literature Review

Abstract

Molar pregnancy in cesarean scar is an extremely rare condition. It has a high risk of uterine rupture and bleeding. There is a small number of case reports in the literature, so the optimal diagnostic algorithms and management are not clear. We reported a 25-year-old woman who presented to our clinic with amenorrhea for 40 days and vaginal bleeding for 3 days. Transvaginal ultrasonography and serum human chorionic gonadotropin (hCG) level raised suspicion of a molar cesarean scar pregnancy (CSP). Magnetic resonance imaging (MRI) was conducted for further knowledge of the characteristics of the mass. Careful suction curettage under ultrasound guidance was performed. The histologic examination of the tissue confirmed a partial hydatidiform mole. The differential diagnosis between CSP and molar CSP is extremely challenging. Serum hCG, sonogram, and MRI are our tools, but none of them suffice for a definitive diagnosis. Histological examination of the postoperative sample is still the gold standard for the diagnosis of molar CSP; however, MRI can assist in planning the necessary interventions.

Key words

Doppler ultrasound - pregnancy - cesarean scar pregnancy - magnetic resonance imaging - molar pregnancy - cesarean section

Publikationsverlauf

Eingereicht: 06. April 2020

Angenommen nach Revision: 29. Juli 2020

Artikel online veröffentlicht:
18. November 2020

• References

• 1 Litwicka K, Greco E. Caesarean scar pregnancy: a review of management options. Curr Opin Obstet Gynecol 2013; 25: 456-461 doi:10.1097/GCO.0000000000000023
• 2 Niemann I, Vejerslev LO, Frøding L. et al. Gestational trophoblastic diseases – clinical guidelines for diagnosis, treatment, follow-up, and counselling. Dan Med J 2015; 62: A5082
• 3 Jurkovic D, Hillaby K, Woelfer B. et al. First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment Cesarean section scar. Ultrasound Obstet Gynecol 2003; 21: 220-227
• 4 Wu CF, Hsu CY, Chen CP. Ectopic molar pregnancy in a cesarean scar. Taiwan J Obstet Gynecol 2006; 45: 343-345 doi:10.1016/S1028-4559(09)60257-6
• 5 Michener C, Dickinson JE. Caesarean scar ectopic pregnancy: a single centre case series. Aust N Z J Obstet Gynaecol 2009; 49: 451-455 doi:10.1111/j.1479-828X.2009.01067.x
• 6 Ko JK, Wan HL, Ngu SF. et al. Cesarean scar molar pregnancy. Obstet Gynecol 2012; 119: 449-451
• 7 Dağdeviren EG, Dur R, Fadıloğlu E. et al. Molar pregnancy in cesarean section scar: a case report. Turk J Obstet Gynecol 2017; 14: 249-251
• 8 Ling C, Zhao J, Qi X. Partial molar pregnancy in the cesarean scar: A case report and literature review Medicine (Baltimore) 2018; 97: e11312
• 9 Zhang Y, Gu Y, Wang JM. et al. Analysis of cases with cesarean scar pregnancy. J Obstet Gynaecol Res 2013; 39: 195-202
• 10 Timor-Tritsch IE, Monteagudo A, Calì G. et al. Cesarean scar pregnancy: diagnosis and pathogenesis. Obstet Gynecol Clin North Am 2019; 46: 797-811
• 11 Soto-Wright V, Bernstein M, Goldstein DP. et al. The changing clinical presentation of complete molar pregnancy. Obstet Gynecol 1995; 86: 775-779
• 12 Niemann I, Petersen LK, Hansen ES. et al. Differences in current clinical features of diploid and triploid hydatidiform mole. BJOG 2007; 114: 1273-1277
• 13 Lurain JR. Gestational trophoblastic disease I: epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole. Am J Obstet Gynecol 2010; 203: 531-539 doi:10.1016/j.ajog.2010.06.073
• 14 Yamada Y, Ohira S, Yamazaki T. et al. Ectopic molar pregnancy: diagnostic efficacy of magnetic resonance imaging and review of the literature. Case Rep Obstet Gynecol 2016; 2016: 7618631
• 15 Timor-Tritsch IE, Monteagudo A, Calì G. et al. Cesarean scar pregnancy: patient counseling and management. Obstet Gynecol Clin North Am 2019; 46: 813-828
• 16 Ben Nagi J, Ofili-Yebovi D, Sawyer E. et al. Successful treatment of a recurrent Cesarean scar ectopic pregnancy by surgical repair of the uterine defect. Ultrasound Obstet Gynecol 2006; 28: 855-856
• 17 Sadeghi H, Rutherford T, Rackow BW. et al. Cesarean scar ectopic pregnancy: case series and review of the literature. Am J Perinatol 2010; 27: 111-120