Differential Diagnosis of Cesarean Scar Pregnancies and Other Pregnancies Implanted in the Lower Uterus by Ultrasound Parameters.

Kangning Li,Qing Dai

doi:10.1155/2020/8904507

Abstract

Purpose Cesarean scar pregnancy is an extremely rare type of ectopic pregnancy implanted in the myometrium at the site of a previous cesarean section scar. On the other hand, pregnancies are considered low implantations if they are identified in the lower third of the uterus without the sac implanted into the scar and have a better prognosis. Early diagnosis of both types of pregnancies can help avoid serious complications. This study is aimed at investigating the significance of transvaginal ultrasound in the differential diagnosis of cesarean scar pregnancies and pregnancies implanted in the lower uterus. Methods Ninety-three patients with an average age of 32.7 years (range, 24–43 years) were enrolled in this study, including 66 cesarean scar pregnancies and 27 other pregnancies implanted in the lower uterus, and they were examined by transvaginal ultrasound. Results We observed significant differences in the relationship between the cesarean sac and the scar, the source of the trophoblastic blood flow, and the thickness of the residual muscle between the cesarean scar pregnancy group and the lower uterus pregnancy group. We established the logistic model to improve the differential diagnosis of cesarean scar pregnancies and pregnancies implanted in the lower uterus. Conclusions Transvaginal ultrasound is recommended in early pregnancy, especially for patients who have undergone a previous cesarean section delivery.

Highlights

Cesarean scar pregnancy is one type of ectopic pregnancy in which the gestational sac is implanted into the prior cesarean scar, and its morbidity has been rapidly rising with the increased rate of cesarean deliveries [1, 2]
Women with a prior cesarean scar pregnancy have a high risk of recurrence, miscarriage, preterm birth, and placenta accreta spectrum, but it remains unclear whether different types of management impact reproductive outcome [4]
When the thickness of the residual muscle was regarded as the independent diagnostic indicator, the area under the receiver operating characteristic (ROC) curve was 0.806, which was taken as a moderate diagnostic value (Figure 6(a))

Summary

Introduction

Cesarean scar pregnancy is one type of ectopic pregnancy in which the gestational sac is implanted into the prior cesarean scar, and its morbidity has been rapidly rising with the increased rate of cesarean deliveries [1, 2]. Cesarean scar pregnancy with positive embryonic/fetal heart activity managed expectantly is associated with a high burden of maternal morbidity [3]. Women with a prior cesarean scar pregnancy have a high risk of recurrence, miscarriage, preterm birth, and placenta accreta spectrum, but it remains unclear whether different types of management impact reproductive outcome [4]. It is still difficult to differentiate between cesarean scar pregnancies and pregnancies implanted in the lower uterus, which includes the implantation of gestational sacs in the lower anterior uterus

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Conclusion