Clinical case of expectant tactics of scar pregnancy and childbirth in the III trimester

Abstract

One of the rare complications of a previous cesarean section is pregnancy with implantation in the area of the postoperative scar. The literature describes isolated reports of this pathology, which relate to early pregnancy. The forecast and tactics of their management are debatable issues.This article presents a case of successful monitoring of pregnancy and childbirth of a patient with a combined pathology: the placenta in the area of the cesarean scar with its diastase and central placenta previa with the germination of the uterine wall.The 34-year-old pregnant woman (III pregnancy and II expected childbirth) during ultrasound examination central a placenta previa was diagnosed. It had ingrowth into the uterine wall creating defect of the cesarean scar. Informed about the possible risks, patient strongly insisted on prolonging the pregnancy. Since 23 weeks she was in an obstetric hospital for the possibility of urgent surgery. Within 37 weeks, a planned caesarean section was performed by bottom access with subsequent extirpation of the uterus. Literary data from different countries almost all describe the completion of cesarean scar pregnancy in the first and second trimesters. Due to the rarity, heterogeneity of groups and the lack of a single protocol for the management of this pathology, combined or modified approaches to treatment are more often used. Primary prevention should begin at the stage of preventing a high frequency of cesarean section, reviewing the indications for it and conducting a truly justified surgery. Preconceprion care should be mandatory when planning the next pregnancy. Great attention should be paid to the localization of the chorion in the protocol of the screening ultrasound examination of the first trimester if there is uterine scar. In the case of a cesarean scar pregnancy, we cannot recommend an expectant tactics at this stage. Any method that eliminates cesarean scar pregnancy, especially in the early term, will saving the body and future fertility, as well as reduces morbidity and mortality.