Management of a Viable Cesarean Scar Pregnancy: A Case Report (original) (raw)

Successful Surgical and Medical Management of Cesarean Scar Pregnancy in 2 Patients

Journal of Gynecologic Surgery, 2014

Background: Cesarean scar pregnancy (CSP), once a rare entity, is on the rise due because of an increase in the cesarean section rate worldwide. Currently, there is no standard protocol available for managing CSP. To contribute to the existing literature, this article presents the current authors' experience with 2 cases of CSP that were treated successfully with two different modalities. Cases: Case 1: A 34-year-old, gravida 2, para 1, was diagnosed with a CSP on initial transvaginal ultrasound (TVUS) scan at 6 weeks of gestation. Aspiration of the gestational sac and a local injection of methotrexate was performed. After 2 weeks, the gestational sac increased in size with thinning of the CS scar (1 mm), and plateauing of the ß-human chorionic gonadotropin (ß-hCG) occurred. Laparoscopic excision of the CSP and myometrial repair resulted in resolution. Case 2: A 31-year-old, gravida 3, para 1, achieved pregnancy after a frozen-thawed embryo transfer cycle. A TVUS scan, performed at 6 weeks of gestation showed a CSP. The patient's ß-hCG level was 310 mIU/mL. Systemic methotrexate was administered intramuscularly. The patient's ß-hCG on days 4 and 7 was 260 and 252, respectively. A repeat TVUS on day 7 showed a resolving gestational sac. A second dose of methotrexate resulted in complete resolution of the CSP. Results: The treatments (aspiration, methotrexate, and laparoscopic excision for Case 1, and methotrexate for Case 2) enabled resolution of the CSPs of these 2 patients. Conclusions: Various treatment modalities have been described for managing CSP with varied levels of success. When local injection of methotrexate into the gestational sac of CSP is unsuccessful, laparoscopic removal is safe and effective. Moreover, in the presence of low levels of b-hCG, treatment with systemic methotrexate is usually successful.

Caesarean Scar Pregnancy: A Case Report and the Review of Literature

2019

Article History Received: 07.10.2018 Accepted: 16.10.2018 Published: 30.10.2018 Abstract: Caesarean scar Pregnancy (CSP) implanted in the caesarean section scar is a rare location among ectopic pregnancies that can be life-threatening. It can be classified at the same level of gravity as the placenta accreta. Hysterectomy is the gold standard treatment for massive bleeding. The diagnosis of pregnancy implanted in the caesarean section scar is a difficult diagnosis of the first trimester. It must be done as early as possible. Clinical manifestations are not specific, bleeding and pain is the most common symptoms. Endovaginal and pelvic ultrasound associated with Doppler is the first-line examination, provides optimal and panoramic vision, and studies reports of the gestational sac and its vasculature. Recent studies report the value of MRI in diagnosis because of its affinity for the study of pelvic tissue and the relationship of structures. The treatment remains non-consensual but i...

Cesarean Scar Pregnancy: A Case Series of Diagnosis, Treatment, and Results

Journal of Diagnostic Medical Sonography, 2018

The aim was to collect cases of cesarean scar pregnancy (CSP) and describe the evolution of diagnosis, treatment modalities, and outcome. A retrospective cohort study was conducted of patients who had been diagnosed with CSP. Treatment decision was made according to the type of CSP, levels of beta human chorionic gonadotropin (hCG), and estimated vascularity. Forty cases with CSP were recorded. Overall success of the primary treatment was recorded among 30 of 40 cases (75%) and significantly correlated with degree of vascularity, type of CSP, and beta hCG levels. The treatment methods included serial methotrexate in 20 cases; 15 of them (75%) were successful. In this specific group, we found type 2 scar and high vascularity to be significantly associated with treatment failure. In conclusion, cases with type 2 CSP, high vascularity, and high beta hCG levels should be considered high risk, and extra caution should be taken in choosing treatment modality and follow-up.

Scar Pregnancy a Diagnostic Conundrum: A Case Report

Journal of Nepal Medical Association, 2021

Cesarean scar pregnancy is a rare form of ectopic pregnancy which may lead to uterine rupture and catastrophic hemorrhage. We report a case of cesarean scar pregnancy in a 35-year-old female with the past history of cesarean section presented with complaints of amenorrhoea for 6 weeks and non-specific pain. Two Transvaginal sonography was done 48 hours apart which suggested a cesarean scar pregnancy in one and cervical pregnancy on the other. Magnetic Resonace Imaging showed a well-defined cystic lesion of (21x19)mm2 embedded within the previous cesarean scar which confirmed the diagnosis of cesarean scar pregnancy. Laparotomy unveiled uterus around 6 weeks size and a (3x3)cm2 bulge was noted at the site of previous scar in lower uterine segment, where a small incision was given and the gestational sac was removed following which the uterine incision was closed with 2-0 polyglactin suture. High index of suspicion and prompt diagnosis is ofparamount for reducing morbidity and mortal...

Cesarean Scar Pregnancy Managed with Conservative Treatment

Iranian journal of medical sciences, 2016

Cesarean scar pregnancy (CSP) is a rare, but life-threatening type of ectopic pregnancy. An exact and early diagnosis of CSP is very important for prognosis. The aim of the present study was to describe 4 women with CSP and discuss their clinical presentations, diagnoses, and various management options along with the published literature. Four women with a suspicion of CSP or cervical pregnancy were referred to our hospital between August 2013 and January 2014. All the patients were counseled about medical management options. After the treatment, serum beta human chorionic gonadotropin (ß-hCG) levels were followed weekly until they reached <5 mIU/mL. All the patients were diagnosed at the first trimester, with the average gestational age of 6.4±0.9 weeks. Treatment was systemic methotrexate (MTX) treatment in 3 of the 4 women, requiring no further intervention. The remaining 1 woman was treated with an intragestational administration of MTX. The mean time passed until ß-hCG reach...

Cesarean scar ectopic pregnancy

Fertility and Sterility, 2006

Importance: Cesarean scar ectopic pregnancy (CSEP) has a high rate of morbidity with nonspecific signs and symptoms making identification difficult. The criterion-standard treatment of CSEP has been subject to debate. Objective: This review defines CSEP, discusses pathogenesis and diagnosis, and compares treatment options and outcomes. Evidence Acquisition: A literature review was performed utilizing the term cesarean scar ectopic pregnancy and subsequently selecting only meta-analyses and systematic reviews. Only articles published in English were included. Relevant articles within the reviews were analyzed as necessary. Results: Five basic pathways have been identified in treatment of CSEP: expectant management, medical therapy, surgical intervention, uterine artery embolization, or a combination approach. Expectant management has the highest probability of morbid outcomes, including hemorrhage, uterine rupture, and preterm delivery. Medical management often requires further treatment with additional medication or surgery. Different surgical methods have been explored including uterine artery embolization; dilation and curettage; surgical removal via vaginal, laparoscopic, or laparotomic approach; and hysterectomy. Each method has various levels of success and depends on surgeon skill and patient presentation. Conclusions: Recent research supports any method that removes the pregnancy and scar to reduce morbidity and promote future fertility. Laparoscopic and transvaginal approaches are options for CSEP treatment, although continued research is required to identify the optimal approach. Relevance: As cesarean delivery numbers rise, a subsequent increase in CSEPs can be anticipated. The ability to accurately diagnose and treat this morbid condition is vital to the practice of any specialist in general obstetrics and gynecology. All authors, faculty, and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

Cesarean section scar pregnancy

Journal of Obstetrics and Gynecological Investigations

Introduction: Cesarean section scar pregnancy (CSSP) occurs due to implantation of the gestational sac over the previous cesarean section or hysterotomy scars. Case description: A 40-year-old woman referred to our hospital with a missed period for 5 weeks +3 days, mild vaginal spotting and β-hCG 5770 mIU/ml as a case of ectopic pregnancy. The repeated β-hCG was 8797 mIU/ml and the transvaginal ultrasound (TVS) showed the gestational sac located in the lower anterior quadrant of the uterus behind the urinary bladder (only a thin layer of myometrium separating it from the bladder), close to the internal cervical os and the site of the previous scars. The case was diagnosed as CSSP and managed according to the hospital protocol by systemic multi-dose methotrexate (MTX) with follow-up using β-hCG, TVS and complete blood count (CBC). When the β-hCG result was found to be 60.66 mIU/ml, and the repeated weekly TVS showed a progressive decrease in the size of the gestational sac, the studied woman was discharged from the hospital for follow-up in the outpatient department (OPD). Conclusions: There is no single best treatment to terminate the CSSP, and the procedure with the fewest complications should be selected. Several authors support systemic multi-dose MTX treatment for CSSP with follow-up using TVS, β-hCG and CBC.

Caesarean Scar Pregnancy: A Case Report and a Literature Review

Medicina

Background and Objectives: Caesarean scar pregnancy (CSP) refers to placental implantation on or in the scar of a previous caesarean section and represents a potentially life-threatening condition. CSP is considered a diagnostic challenge in obstetrics, with the diagnosis relying mainly on transvaginal ultrasound (TVS) and the management depending upon case presentation and available healthcare infrastructures. Case Presentation: We present a case of 34-year-old G3P2 with a history of two-previous caesarean sections referred to the outpatient gynaecology clinic of our Department at the 7th week (7/40) of gestation with abnormal early pregnancy TVS findings, illustrating the gestational sac attached to the caesarean scar and a foetal pole with evidence of foetal cardiac activity. We discuss the outcome of an alternative combined medical and surgical approach we followed as well as an updated review of the current literature. Conclusions: The ideal management of CSP requires tertiary ...