Caesarean scar ectopic pregnancy and laparoscopy: a rendezvous

Caesarean scar pregnancy (CSP) is defined as an implantation of pregnancy in a fibrous tissue scar of a previous caesarean section, one of the rarest forms of ectopic pregnancy which can be life threatening. The incidence of CSP is steadily rising in view of increasing caesarean section rates. A very high index of clinical suspicion is required for the diagnosis and further management. As with other ectopic pregnancies, caesarean scar ectopic pregnancy pose a greater risk for maternal haemorrhage and ultimately maternal mortality. Through this case report, we demonstrated the laparoscopic management of a CSP

Ceasarean scar pregnancies, diagnosis and management

Background: Objective of present study was to describe evaluation and management of pregnancies implanted into uterine Cesarean section scars, Ceasarean scar pregnancies (CSP), is defined as gestational sac implanted in the myometrium at the site of a previous ceasarean scar. Also known as Ceasarean ectopic pregnancy.Methods: In all antenatal patients attending the antenatal outpatient department of a tertiary care service hospital a transvaginal sonography was done for determining the gestational age as well as the viability of the pregnancy. In all patients with a history of previous Cesarean section(s), special effort was made to assess the possibility of implantation into the uterine scar by means of an early transvaginal and colour doppler ultrasound.Results: Twelve Cesarean section scar pregnancies were diagnosed in a five-year period, of a tertiary care service hospital. Five (42%) patients with Cesarean scar pregnancies were treated surgically, four patients medically (33%), and two patients expectantly (17%) and one patient opted to continue the pregnancy. Surgical management was successful in all cases, although two of five (40%) women suffered bleeding (300-500ml). In the group of women who were managed medically the success rate was 3/4(75%). Expectant management was successful in one of two cases (50%). One patient who opted to continue pregnancy, underwent a ceasarean hysterectomy at 33 weeks of gestation for placenta accreta.Conclusions: Incidence of ceasarean section scar pregnancies is increasing as is the increasing rate of ceasarean deliveries. A high index of suspicion in all cases of post ceasarean pregnancies, coupled with early transvaginal ultrasonography along with colour doppler confirmation and institution of early and individualized treatment, optimizes the clinical outcome. Although rare, the patient and her relatives must be made aware of the possibility of recurrent CSP

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

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 ?-hCG, treatment with systemic methotrexate is usually successful. (J GYNECOL SURG 30:168)Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140096/1/gyn.2013.0131.pd

Management and outcomes of caesarean scar pregnancy in medina maternity and children hospital

Undergoing previous cesarean section (CS) can have the possibility for implantation of embryonic sac of any later gestation throughout its scar evolving what was known as a scar pregnancy (SP). The aim of this study to describe the diagnosis, treatment and outcomes of caesarean SP in Medina maternity and children hospital. This a case series study encompassed all patient diagnosed and managed as cesarean SP in Medina maternity and children hospital, Medina (MMCH), Saudi Arabia in the period from January 2020 to January 2021. Demographics, clinical and discharge data were attained from the previous hospital electronic records, nursing notes, anesthesia sheets, operative notes, discharge papers, and outpatient clinic documents. A total of 11 women detected by ultrasound (US) and magnetic resonance imaging (MRI) as SP. The mean age of women was 36±3.8 years. The median number of repeated CS was 2 while the mean gestational age was 50.6±7.8 days. The interval from diagnosis to management ranged from 2 to 9 days with a median of 4 days, and the interval between start treatment and negative Beta human chorionic gonadotropin β-hCG ranged from 21 to 135 days with a median of 62 days. The mean interval from last CS until this pregnancy is 39.7±19.2 months. Systemic methotrexate (MTX) given in a single dose for two patients while nine patients received multiple doses. Local MTX given for six cases. Bleeding as a complication occurred with two out of the eleven patients. MTX was actual treatment for SP, but bigger multicenter randomized-controlled trials involving more cases are essential to validate our conclusions

Suction Evacuation with Methotrexate as a Successful Treatment Modality for Caesarean Scar Pregnancies : Case series

Pregnancy resulting from the implantation of an embryo within a scar of a previous Caesarean section is extremely rare. The diagnosis and treatment of Caesarean scar pregnancies (CSPs) are challenging and the optimal course of treatment is still to be determined. We report a case series of six patients with CSPs who presented to the Royal Hospital in Muscat, Oman, between October 2012 and April 2014. All of the patients were successfully treated with systemic methotrexate and five patients underwent suction evacuation either before or after the methotrexate administration. The patients were followed up for a period of 6–9 weeks after treatment and recovered completely without any significant complications. Suction evacuation with methotrexate can therefore be considered an effective treatment option with good maternal outcomes

Combined laparoscopy and hysteroscopy vs. uterine curettage in the uterine artery embolization-based management of cesarean scar pregnancy: a retrospective cohort study

BACKGROUND: The number of cesarean scar pregnancy (CSP) has significantly increased in the recent decade. Although uterine artery embolization (UAE) has been adopted to minimize the blood loss during uterine curettage removing of CSP, massive bleeding and uterine rupture can still be frequently encountered. The aim of this study was to compare the efficacy and safety of a novel combined laparoscopy and hysteroscopy technique with the traditional curettage in removing the conceptus and repairing the incision defect following the UAE management of CSP. METHODS: The CSP patients (n = 58) diagnosed between March 1, 2005 and March 1, 2010 were enrolled in three medical centers in Shanghai, China. All of these patients have undergone intra-arterial methotrexate, UAE and one of the following treatments: combined laparoscopy and hysteroscopy (study group, n = 25) and uterine curettage (control group, n = 33). Their medical records and 2-year outcomes were reviewed. The CSP removal rate, amount of blood loss during the treatment, incision repair rate (note: the post-curettage healing process of the incision defect was seen as a form of natural incision repairing, i.e., the self-repair mode), hospital stay, β-hCG regression time and postoperative sequelae were compared between two groups. RESULTS: The CSP removal rate in the study group (100%) was significantly higher than that (79%) in the control group (p = 0.024). The average blood loss was 78.0 mL in the study group, which was much less than the 258.5 mL (p = 0.004) in the control group. A satisfactory incision repair rate (96%) was achieved in the study group, while it was 25% (p < 0.001) in the control group. Moreover, the study group had significantly shorter hospital stays (p = 0.043) and β-hCG regression times (p = 0.033), lower rates of postoperative abdominal pain (p = 0.035) and menstruation abnormalities (p = 0.043). CONCLUSIONS: Combined laparoscopy and hysteroscopy is much safer and more effective than uterine curettage as a supplementary measure to remove the conceptus and repair the cesarean incision following the UAE management of CSP