Cesarean Scar Ectopic Pregnancy Research Articles

Ruptured Caesarean Scar Ectopic Pregnancy: A Rare Case of Obstetric Hemorrhage

Ruptured Caesarean Scar Ectopic Pregnancy: A Rare Case of Obstetric Hemorrhage

Laparoscopic Excision of Cesarean Scar Ectopic Pregnancy: An Optimum Management Option

Cesarean scar ectopic pregnancy is a leading cause of life-threatening complications in the first trimester. It poses a diagnostic and management challenge; if not diagnosed and adequately treated in early pregnancy, it may lead to considerable maternal morbidity and mortality. We report a case series of cesarean scar ectopic pregnancies managed successfully by laparoscopy. Laparoscopic excision is the gold standard management approach for cesarean scar ectopic pregnancy.

Hysteroscopic subchorionic injection of methotrexate followed by laparoscopic excision of the gestational sac for the management of cesarean scar ectopic pregnancy: an innovative dual approach of a challenging pathology

This innovative two-step therapeutic approach should be considered a compelling option for managing cesarean scar ectopic pregnancy.

Steps to successful laparoscopic management of cesarean scar ectopic pregnancy

Steps to successful laparoscopic management of cesarean scar ectopic pregnancy

Efficacy of Treatment of Cesarean Scar Ectopic Pregnancies with Alcohol Injection to the Gestational Sac and Dilatation Curettage with or without Systemic Methotrexate: A Case-Control Study

Efficacy of Treatment of Cesarean Scar Ectopic Pregnancies with Alcohol Injection to the Gestational Sac and Dilatation Curettage with or without Systemic Methotrexate: A Case-Control Study

Caesarean Scar Ectopic Pregnancy: 11 Case-Series Study in 2 Years at a Tertiary Care Hospital

Objective: The objective of this study was to evaluate the management, clinical features and outcome of caesarean scar pregnancies. Study Design: Descriptive case series. Settings: Department of Obstetrics & Gynecology, Faisalabad Medical University, Faisalabad Pakistan. Duration: Two years from 1st June 2019 to 31st May 2021. Methods: Medical records of the women with diagnosis of CSP were retrieved. The study included cases with gestational ages ranging from 5 weeks to 9 weeks who were referred to us. All the information regarding demographics, age, gestational age, symptoms at presentation, number of Caesarean sections, obstetric and gynecological history, ultrasound images, treatment given to the patients and hospital stay were retrieved from charts of the patients. Results: In this study, 11 cases of CSP were treated. One patient had pain in lower abdomen, two of 11 patients had no symptoms, 3 had lower abdominal pain with vaginal bleeding and 5 had vaginal bleeding only. All patients had history of caesarean sections. Gestational age of these patients was from 5 to 9 weeks. Five patients were treated with Methotrexate (MTX), 3 underwent emergency laparotomy and 3 were managed conservatively. Conclusion: Early diagnosis and management of patients having caesarean scar ectopic pregnancies can reduce the complications associated with this condition.

Case Series: Management Modalities of Caesarean Scar Ectopic Pregnancy

Case Series: Management Modalities of Caesarean Scar Ectopic Pregnancy

Successful management of a rare arteriovenous malformation associated with scar ectopic pregnancy through uterine artery embolization: A case report in interventional radiology

Arteriovenous malformation (AVM) may manifest in Cesarean scar ectopic pregnancy. The diagnostic challenge arises when retained products of conception are present, leading to a clinical presentation similar to that of a raised beta-human chorionic gonadotropin (HCG) titre, necessitating the exclusion of neoplastic etiology. Interventional Radiology (IR) opinion and uterine artery embolization stand as a treatment alternative to hysterectomy in such cases. A 26-year-old female presented with continuous vaginal bleeding persisting for 16–18 days following a pharmacological termination of pregnancy. She had a history of three previous Cesarean sections. Color Doppler imaging revealed an anterior myometrial mass with dilated tortuous vessels in the lower uterine segment, indicative of scar ectopic pregnancy with arteriovenous malformation (AVM). An Magnetic resonance imaging (MRI) was performed to assess the extent of the lesion. The oncology profile was evaluated and cleared. Digital subtraction angiography confirmed the diagnosis. Bilateral uterine artery embolization successfully achieved complete devascularization, as confirmed on the post-intervention angiogram. The patient became symptom-free after that. Interventional Radiology, specifically uterine artery embolization, serves as an effective treatment for arteriovenous malformation (AVM) and excessive vaginal bleeding. It presents a viable alternative to hysterectomy, particularly when preserving future fertility is a consideration.

Surgical evacuation combined with Shirodkar cervical suture and selective uterine artery embolization: A fertility preserving treatment for 10-15 weeks' live cesarean scar ectopic pregnancies.

Cesarean scar ectopic pregnancies (CSEPs) are associated with significant maternal morbidity and termination is often recommended in the early first trimester. Management of more advanced cases is challenging due to higher risks of major intraoperative hemorrhage. Hysterectomy is currently the intervention of choice for advanced cases. This study aimed to investigate if advanced live CSEPs could be managed effectively conservatively using suction curettage and interventional radiology. A retrospective single-center cohort study was performed. A total of 371 women diagnosed with CSEP were identified between January 2008 and January 2023. A total of 6% (22/371) women had an advanced live CSEP with crown-rump length (CRL) of ≥40 mm (≥10 weeks' gestation). Of these, 77% (17/22) opted for surgical intervention, whilst the remaining five continued their pregnancies. A preoperative ultrasound was performed in each patient. All women underwent suction curettage under ultrasound guidance and insertion of Shirodkar cervical suture as a primary hemostatic measure combined with uterine artery embolization (UAE) if required. The primary outcome was rate of blood transfusion. Secondary outcomes were estimated intraoperative blood loss, UAE, intensive care unit admission, reintervention, hysterectomy, hospitalization duration and rate of retained products of conception. Descriptive statistics were used to describe these variables. Median CRL of the 17 patients included was 54.1 mm (range: 40.0-85.7) and median gestational age based on CRL was 12 + 3 weeks (range: 10 + 6-15 + 0). On preoperative ultrasound scan placental lacunae were recorded in 76% (13/17) of patients and color Doppler score was ≥3 in 67% (10/15) of patients. At surgery, Shirodkar cervical suture was used in all cases. It was successful in achieving hemostasis by tamponade in 76% (13/17) of patients. In the remaining 24% (4/17) patients tamponade failed to achieve complete hemostasis and UAE was performed to stop persistent arterial bleeding into the uterine cavity. Median intraoperative blood loss was 800 mL (range: 250-2500) and 41% (7/17) women lost >1000 mL. 35% (6/17) needed blood transfusion. No women required hysterectomy. Surgical evacuation with Shirodkar cervical suture and selective UAE is an effective treatment for advanced live CSEPs.

A skillful approach in a case of caesarean scar ectopic pregnancy

Key to a successful outcome in a rare life threatening condition like cesarean scar ectopic pregnancy is early diagnosis and treatment. The risk of massive haemorrhage can lead inevitably to a hysterectomy in past. The most effective method of treatment is not yet found. We report a case of a previous LCSC and one D& E of 35-year-old female (G3P1A1L1) with 7 weeks of amenorrhea and vaginal bleeding. A gestational sac with an embryo in the cesarean scar canal was seen on ultrasonography. The fertility-sparing therapeutic strategy involved cesarean scar curettage to remove the trophoblastic under ultrasound.

Transvaginal sonographic diagnosis of caesarean scar ectopic pregnancy: A case report

We report a case of scar ectopic pregnancy which is the rarest type of all ectopic pregnancies. We need to diagnose & treat this condition in the early weeks of pregnancy to avoid the complication. This case of Caesarean scar ectopic pregnancy (CSEP) was diagnosed during an antenatal ultrasound scan, at six weeks of pregnancy. An ultrasound scan of this case revealed the gestation sac in the lower uterine segment at the previous caesarean scar.

264 BhCG decline following intrasac methotrexate for the management of cesarean-scar ectopic pregnancy: An 11-year experience.

264 BhCG decline following intrasac methotrexate for the management of cesarean-scar ectopic pregnancy: An 11-year experience.

Cesarean Scar Ectopic Pregnancy: Experience From Benghazi Medical Center, 2022

Background: Cesarean scar pregnancy (CSP) is a rare consequence of a previous cesarean delivery and a new type of ectopic pregnancy, but it is life-threatening if unrecognized and inadequately managed. Despite the rising incidence of CSP, there are no consensus or evidence-based guidelines for management. Aims: To review risk factors, clinical features, diagnostic methods, and management of women with CSP at Benghazi Medical Center. Materials and methods: A descriptive-case series study of CSP cases between the Ist of March 2018 and Ist of April 2022.. Data collected retrospectively. The data included demographics, presenting symptoms and signs, ultrasound findings, treatment used, and any complications. Results: The total number of ectopic pregnancies in period between 1st March 2018 and 1st April 2022 was 262, ten women (3.82%) were diagnosed as scar ectopic, The women's ages ranged from 28 to 47 years, about 60% had three or four previous cesarean scars, abdominal pain with vaginal bleeding was in 30% of the cases, while 60% of patients were asymptomatic and all patients were stable during the diagnosis, except for one case that had signs of shock. ultrasound finding was 80% presence of gestational sac implanted low near the previous scar; initial diagnosis was delayed by 50%. The management was laparotomy and gestational sac excision in four cases that did not require further treatment, dilatation and uterine evacuation were done in two cases that required use of uterine balloon to control bleeding and further use of methotrexate In one case (10%), systemic methotrexate alone was effective. Severe bleeding was seen among 60% of women, and 20% underwent hysterectomy. The complications were significantly (P< 0.05) more common among women with high parity and also in cases where there was no intervention during the diagnosis. Conclusion: A previous uterine scar is the main risk factor for CSP; there is no specific clinical feature for CSP; ultrasound is used for the diagnosis; surgical management appears to be a better option, serious complications were seen mainly when no intervention was done during the diagnosis.

Efficacy, Safety and Outcomes of the Laparoscopic Management of Cesarean Scar Ectopic Pregnancy as a Single Therapeutic Approach: A Case Series.

A standardized consensus for the management of cesarean scar pregnancy (CSP) is lacking. The study objective is to evaluate the efficacy, safety and outcomes of the laparoscopic management of CSP as a single therapeutic surgical approach without being preceded by vascular pretreatment or vasoconstrictors injection. This is a retrospective bi-centric study, a case series. Eight patients with a future desire to conceive underwent the laparoscopic treatment of unruptured CSPs. Surgery consisted of "en bloc" excision of the deficient uterine scar with the adherent tissue of conception, followed by immediate uterine repair. The data collected for each patient was age, gestity, parity, number of previous c-sections, pre-pregnancy isthmocele-related symptoms, gestational age, fetal cardiac activity, initial β-human chorionic gonadotropin levels, intra-operative blood loss, blood transfusion, operative time and the postoperative complications, evaluated according to Clavien-Dindo classification. The CSP was successfully removed in all patients by laparoscopy. The surgical outcomes were favorable. All patients with histories of isthmocele-related symptoms reported postoperative resolution of symptoms. The median residual myometrium thickness increased significantly from 1.2 mm pre-operatively to 8 mm 3 to 6 months after surgery. The laparoscopic management seems to be an appropriate treatment of CSP when performed by skilled laparoscopic surgeons. It can be safely proposed as a single surgical therapeutic approach. Larger series and further prospective studies are needed to confirm this observation and to affirm the long-term gynecological and obstetrical outcomes of this management.

A Rare Case Report of Caesarean Scar Ectopic Pregnancy

Caesarean scar pregnancy is rarest pregnancy, increasing incidence due to increasing in number of caesarean deliveries. It is defined as blastocyst implants on a previous caesarean scar Herman A. Early diagnosis can be done by using ultrasound with empty uterus and cervix, mass in the anterior wall of uterus in scar area. Early diagnosis leads to prompt management and improves the outcome by allowing preservation of future fertility and decreases maternal morbidity and mortality, this is possible with ultrasound imaging. When ultrasound is inconclusive or equivocal then MRI has important role in diagnosis before therapy or intervention. Here we are presenting a case of G11P2+(1)L2A7 with previous two caesarean deliveries, diagnosed as caesarean scar ectopic pregnancy with the help of sonography. Patient underwent laparotomy and on histopathology report, caesarean scar pregnancy was confirmed.

Management of Caesarean Scar Ectopic Pregnancy Via Robotic Caesarean Scar Defect Repair – a Video Presentation

Management of Caesarean Scar Ectopic Pregnancy Via Robotic Caesarean Scar Defect Repair – a Video Presentation

Conservative management of Caesarean scar site ectopic pregnancy with morbidly adherent placenta: a challenging scenario

Conservative management of Caesarean scar site ectopic pregnancy with morbidly adherent placenta: a challenging scenario

Predictive Role of Beta hCG for The Outcome of the Tubal and Cesarean Scar Ectopic Pregnancy: A retrospective study

Predictive Role of Beta hCG for The Outcome of the Tubal and Cesarean Scar Ectopic Pregnancy: A retrospective study

Early pregnancy loss medical management in clinical practice

ObjectivesThis study aimed to review clinical practice outcomes of early pregnancy loss (EPL) medical management using mifepristone and misoprostol outside of a clinical trial setting. Study designIn this retrospective cohort study, we reviewed a deidentified database of patients who received mifepristone-misoprostol for EPL from May 2018 to May 2021 at our academic center–based clinic, which was a study site for a multicenter mifepristone-misoprostol EPL trial completed in March 2018. All patients received mifepristone 200 mg orally and misoprostol 800 mcg vaginally or buccally, with clinic follow-up typically scheduled within 1 week. The primary outcome was successful medical management, defined as management without the need for aspiration, and the secondary outcomes included additional interventions and indications, follow-up ultrasonography findings, and adverse events requiring treatment. ResultsWe treated 90 patients with a median ultrasound-measured gestational size of 49 (range 30–80) days and median time from mifepristone to misoprostol of 24 (range 8–66) hours. Follow-up was completed in clinic by 80 (88.9%), completed remotely by five (5.6%), and not completed by five (5.6%) patients. Overall, 76 (95% CI 82.9%–96.0%) of 85 patients (89.4%) with follow-up were successfully managed without uterine aspiration. Eighty patients had initial follow-up ultrasonography interpreted as gestational sac expulsion; seven (8.8%) of these ultimately underwent aspiration, including one patient who had a previously undiagnosed cesarean scar ectopic pregnancy. Two patients had significant safety outcomes: one pelvic infection and one blood transfusion during aspiration in the patient with a cesarean scar ectopic pregnancy. ConclusionsOutside of a clinical trial setting, medical management of EPL with mifepristone and misoprostol remains effective and safe. ImplicationsMedical management of EPL with mifepristone and misoprostol is effective and safe outside of a clinical trial setting. A standardized protocol based on the best available clinical trial evidence can be used in clinical practice for the medical management of EPL.

Definition and diagnosis of cesarean scar ectopic pregnancies

Cesarean scar ectopic pregnancy is a rare type of ectopic pregnancy, where the pregnancy implants into a myometrial defect caused by a cesarean scar. Its incidence is predicted to increase given the global increase in cesarean deliveries. As most cesarean scar ectopic pregnancies present as failing pregnancies or patients chose termination of pregnancy, there is limited data on their natural history. However, early first trimester diagnosis is essential given the associated significant maternal morbidity. Transvaginal sonography is generally considered to be the optimal method for diagnosing cesarean scar ectopic pregnancy. There is no evidence that MRI adds to the diagnostic accuracy, and it is therefore not recommended for routine evaluation of cesarean scar ectopic pregnancy. There is no agreed reference standard for the diagnosis of cesarean scar ectopic pregnancy; therefore the validity of several proposed sonographic diagnostic criteria reported by different authors remains unknown. There are also various suggested classification systems for cesarean scar ectopic pregnancies, which divide them in differet types. However, the proposals are very heterogeneous and superiority of one classification system over another is yet to be established.