Cesarean Scar Ectopic Pregnancy Research Articles

Hemodynamically Unstable Cesarean Ectopic Pregnancy

Video Objective To review cesarean ectopic pregnancy and evaluation of patient hemodynamic status by calculating estimated blood loss (EBL), class of hemorrhagic shock, and shock index (SI). This is a case example of conservative surgical treatment for cesarean scar ectopic pregnancy in the face of hemodynamic instability. Setting Mount Sinai Hospital and Medical Center in Chicago, Illinois. Interventions A 33 year old G4P2103 at 6w2d with history of one prior cesarean section was transferred to our institution from a tertiary care center for findings consistent with cesarean ectopic pregnancy. The patient was in class II hemorrhagic shock, with EBL of 1.4L and a SI of 1.03, warranting immediate surgical management. Diagnostic laparoscopy showed a 3cm cesarean ectopic pregnancy in the lower uterine segment (LUS) near the isthmic region. Uterine arteries were ligated bilaterally to minimize blood loss. The gestational sac was carefully excised from the LUS and the isthmocele was repaired using a double layer closure with imbrication. Intraoperative EBL was 35mL and 2U of PRBCs were transfused during the procedure. Conclusion Cesarean ectopic pregnancy is uncommon and carries risk of massive hemorrhage, therefore timely assessment of hemodynamic status is vital in guiding management. Our patient was promptly evaluated and successfully treated for a hemodynamically unstable type 1 cesarean scar pregnancy by laparoscopic cesarean ectopic resection and isthmocele repair.

EP28.21: Heterotrophic pregnancy, Caesarean scar pregnancy and tubal ectopic pregnancy simultaneously

EP28.21: Heterotrophic pregnancy, Caesarean scar pregnancy and tubal ectopic pregnancy simultaneously

EP28.23: Successful term pregnancy after previous treatment of Caesarean scar ectopic pregnancy with methotrexate infusion into the gestational sac

EP28.23: Successful term pregnancy after previous treatment of Caesarean scar ectopic pregnancy with methotrexate infusion into the gestational sac

EP29.04: Recurrent Caesarean scar ectopic pregnancy treated with local and systemic methotrexate

EP29.04: Recurrent Caesarean scar ectopic pregnancy treated with local and systemic methotrexate

Cesarean-Scar Ectopic Pregnancy: A Rare Case

Abstract Background: Cesarean-scar ectopic pregnancy is the rarest form of ectopic pregnancy. Such a pregnancy is prone to complications, including uterine rupture, life-threatening hemorrhage, and...

Successful Vaginal Delivery in a Woman with Previous Caesarean Scar Ectopic Pregnancy: A Case Report and Literature Review

Background: Caesarean scar implantation is a rare form of ectopic pregnancy. Subsequent pregnancies following CSP is usually associated with complications such as first or second trimester miscarriage, placenta previa or accreta causing life threatening haemorrhage, emergency hysterectomy and uterine rupture threatening lives of mother and fetus. Given the lack of consensus on treatment modalities of CSP and subsequent pregnancy, babies are usually delivered by caesarean section at term. We report on a case describing uncomplicated pregnancy course and successful vaginal delivery of a woman who had had caesarean scar ectopic pregnancy previously. Case: We report on a case of 38 year old, Gravida 7 P2+4, who was diagnosed with a CSP in her 5th pregnancy and was managed by evacuation of caesarean scar ectopic pregnancy. She presented to us again on her 7th pregnancy in early pregnancy assessment unit (EPAU) at 7+6 weeks. As she had recurrent miscarriage, Aspirin, Tinzaparin and Cyclogest were started after dating scan. She also developed gestational diabetes, hence, Metformin and Insulin was initiated. She was induced with Dinoprostone at 37+3weeks of pregnancy. Labour was conducted under epidural analgesia and the fetus was continuously monitored throughout labour. Obstetric management was largely based upon current literature and professional experience as there are not sufficient relevant cases published in literature neither specific guideline for the management in subsequent pregnancy after CSP. Results: A Healthy baby of birth weight 3.19kg was delivered without complications with second degree perineal tear. Conclusion: Although, subsequent pregnancy following caesarean scar pregnancy is associated with significant morbidity at all stages of pregnancy, hence, is recommended to deliver women by caesarean section at term, this case demonstrates that vaginal delivery is an option with careful case selection, close monitoring and informed consent from patient

Isthmocele: an overview of diagnosis and treatment.

An isthmocele, a cesarean scar defect or uterine niche, is any indentation representing myometrial discontinuity or a triangular anechoic defect in the anterior uterine wall, with the base communicating to the uterine cavity, at the site of a previous cesarean section scar. It can be classified as a small or large defect, depending on the wall thickness of the myometrial deficiency. Although usually asymptomatic, its primary symptom is abnormal or postmenstrual bleeding, and chronic pelvic pain may also occur. Infertility, placenta accrete or praevia, scar dehiscence, uterine rupture, and cesarean scar ectopic pregnancy may also appear as complications of this condition. The risk factors of isthmocele proven to date include retroflexed uterus and multiple cesarean sections. Nevertheless, factors such as a lower position of cesarean section, incomplete closure of the hysterotomy, early adhesions of the uterine wall and a genetic predisposition may also contribute to the development of a niche. As there are no definitive criteria for diagnosing an isthmocele, several imaging methods can be used to assess the integrity of the uterine wall and thus diagnose an isthmocele. However, transvaginal ultrasound and saline infusion sonohysterography emerge as specific, sensitive and cost-effective methods to diagnose isthmocele. The treatment includes clinical or surgical management, depending on the size of the defect, the presence of symptoms, the presence of secondary infertility and plans of childbearing. Surgical management includes minimally invasive approaches with sparing techniques such as hysteroscopic, laparoscopic or transvaginal procedures according to the defect size.

Cesarean Scar Ectopic Pregnancy - Operative Management with Bilateral Temporary Iliac Artery Occlusion

Objective: The paper describes management of cesarean scar pregnancy with bilateral internal iliac artery occlusion prior to operative removal of the gestational sac.Methods: Both internal iliac arteries were temporally occluded before the operation to assure perioperative bleeding control.Results: The bleeding was well controlled during the operation and the cesarean scar pregnancy was safely removed. The anterior uterine wall healed completely within 8 weeks postoperatively. The total blood loss was approximatey 1150 ml.Conclusions: Bilateral internal iliac artery occlusion is a safe and effective method of perioperative bleeding control in patients diagnosed with cesarean scar pregnancy.

Uterine Artery Embolization and Methotrexate Infusion as Sole Management for Caesarean Scar and Cervical Ectopic Pregnancies: A Single-Center Experience and Literature Review

IntroductionThe incidence of caesarean scar pregnancy (CSP) and cervical pregnancy (CP) has increased significantly in recent years. The related hemorrhage can be lethal and often needs hysterectomy. This study aims to assess the technical and clinical results of uterine artery embolization (UAE) combined with intra-arterial methotrexate (MTX) infusion for CSP and CP. MethodsA retrospective study was conducted for 11 patients (age range from 25–40 years, mean; 31.8 y) with CSP (7/11) and CP (4/11). The diagnosis was confirmed by elevated b-hCG levels (mean 31.245 mIU/mL) with sonography and/or magnetic resonance imaging. They were treated with UAE using particulate embolic material. In all patients, the infusion of MTX (50 mg/m2) was performed before UAE. Follow-up periods after UAE ranged between 6-24 months included weekly sonography and b-hCG level assessment. A literature review was performed using standard online search tools. ResultsIn 10 patients, UAE controlled active vaginal bleeding and reduced post-procedural b-hCG levels significantly by the second week. One patient presented with persistent elevated b-hCG level and vaginal rebleeding. The rebleeding was successfully controlled by second UAE procedure. The ectopic pregnancies were resolved, and the uterus was preserved in all patients. No major complications were detected. Normal menses resumed within 2 months after UAE. Two patients had subsequent natural successful intrauterine pregnancies. ConclusionUAE combined with intra-arterial MTX infusion resulted in resolution of ectopic pregnancies with control of hemorrhage and without hysterectomy in this small group of patients.

Cesarean scar ectopic pregnancy, a life threatening condition: a case report

A cesarean scar ectopic pregnancy (CSEP) is a rare and life-threatening condition with a prevalence of one over 3, 000 pregnancies. If not promptly diagnosed, patients may undergo fatal results. There is no consensus for the management of this type of ectopic pregnancy. The authors present a series of three cases involving different clinical scenarios for the management of cesarean ectopic pregnancy. The diagnosis was made using laboratory results, ultrasound images, and surgery. Treatment was performed using different techniques according to this hospital’s capabilities; from surgery to methotrexate use, all with satisfactory results. The authors discuss the clinical significance and differential diagnosis of CSEP in the setting of a second level reference hospital.

Ultrasound Guided Transvaginal Aspiration and Mechanical Destruction with Local Methotrexate Injection is a Promising Primary Treatment Approach for Caesarean Scar Ectopic Pregnancy (CSEP)

Caesarean scar ectopic pregnancy (CSEP) is considered an extremely rare entity, but life threatening, however, with the increase in C/S rates it is becoming a more common finding. To explore the possibility of utilizing ultrasound guided transvaginal aspiration and injection of 50 mg methotrexate followed by mechanical disruption as a promising primary treatment approach for CSEP. In a series of 11 cases at Tawam Hospital (UAE) diagnosed with CSEP, an ultrasound guided transvaginal aspiration of the amniotic fluid and gestational tissue, followed by injection of 50 mg Methotrexate into the remaining chorionic sac and then disruption of the sac with the needle. B-hCG level were measured on: day of procedure, day 1 or 2 after the procedure and then weekly. Final resolution was considered when B-hCG returned to < 5mIU/mL. All cases presented and diagnosed in the 1st trimester, mean gestational age at diagnosis was 6.6 weeks (range 5-10). The presenting symptoms were mainly lower abdominal pain and vaginal bleeding in 8/11 patients (73%) while three women were asymptomatic (27%) and CSEP was diagnosed incidentally at viability scan. Nine out of eleven cases showed cardiac activity (82%). B-hCG day 1 or 2 post procedure dropped in all cases but by variable levels, ranging from 1.1% to 74.7%, while the drop during days 7-10, was more significant and reassuring; ranged from 45.7% to 92.5 %. No complications were reported with 100% success rate. Ultrasound guided transvaginal aspiration and injection of 50 mg Methotrexate followed by needle mechanical disruption is a promising primary treatment approach for CSEP. However, more studies with more numbers are needed to further support this treatment method.

55: Robot-assisted multiport hysterotomy with resection of cesarean scar ectopic pregnancy involving the cervix and metroplasty

55: Robot-assisted multiport hysterotomy with resection of cesarean scar ectopic pregnancy involving the cervix and metroplasty

Concurrent tubal ectopic pregnancy with cesarean scar ectopic pregnancy: World's first case report

Concurrent tubal ectopic pregnancy with cesarean scar ectopic pregnancy: World's first case report

Management of Cesarean Scar Pregnancy among Vietnamese Women.

Objective:To demonstrate the efficacy of management for cesarean scar ectopic pregnancies up to 8 weeks’ gestation using ultrasound-guided Foley balloon catheter placement combined with dilation and curettage (D and C) at TuDu Hospital.Subjects and Methods:A quasi-experimental study was conducted from March 2015 to March 2016. Patients with imaging-confirmed cesarean ectopic pregnancies were admitted to an inpatient unit at Tu Du Hospital. A Foley balloon catheter was placed inside the uterus under ultrasound guidance and was left in place for 24 h. Afterward, the patient underwent ultrasound-guided D and C. Follow-up to confirm success included serial blood draws to measure beta-human chorionic gonadotropin (β-hCG) levels until a value of 0, and routine ultrasounds to confirm absence of a gestational sac and no evidence of vascularity at the site of the cesarean section scar.Results:A total of 311 patients were enrolled over 3 months. Overall, 90.7% (95% confidence interval [CI]: 86.8%–93.9%) patients were successfully treated with this regimen. Several factors that were significantly associated with successful management included gestational age <6 weeks (odds ratio [OR] 3.1, 95% CI: 1.03%–8.76%), β-hCG level <11,000 mUI/mL before discharge from the hospital (OR 6.5, 95% CI: 1.42%–30.6%), gestational sac volume 2 weeks after treatment measuring <5 cm3 (OR 9.1, 95% CI: 1.96%–50.1%).Conclusions:This is an easily applicable method with a short follow-up period and reduction in treatment costs compared to standard treatment with methotrexate injection.

Caesarean scar ectopic pregnancy: imaging findings of this rare but potentially life-threatening condition

Caesarean scar ectopic pregnancy: imaging findings of this rare but potentially life-threatening condition

A single centre’s experience of caesarean scar pregnancy and proposal of a management algorithm

The management of a caesarean scar pregnancy ranges from conservative medical therapy to surgical treatment. The aim of this study is to present our experience of caesarean scar ectopic pregnancies treated with different modalities and to develop a management algorithm. This retrospective clinical analysis included 21 caesarean scar pregnancies. The clinical data, ultrasonographic characteristics, b-human chorionic gonadotropin concentrations, the treatment options and complications were noted. One patient was managed expectantly, six patients were treated with D and C, seven patients were treated with systemic methotrexate, eight patients underwent a caesarean scar pregnancy removal with a laparoscopy, three patients were treated with a hysteroscopy. Three patients who recieved a methotrexate required additional treatment methods including a laparoscopy, hysteroscopy and D and C. Surgery was successful in all cases. An intra-abdominal haemorrhage from the vessels in the scar area occured in the patient managed expectantly, and a laparatomy and removal was performed. A systemic methotrexate, dilatation and curettage, hysteroscopic resection and laparoscopic resection are feasible methods for scar pregnancy treatment depending on the gestational age, β-hCG level, the type of scar pregnancy and the clinical status of the patient.IMPACT STATEMENTWhat is already known on this subject? CSP has increased gradually parallel to the increased rates of CS worldwide. There is no treatment consensus on that rare entity.What do the results of this study add? We aimed to present our cases and to discuss a proposal algorithm with further studies.What are the implications of these findings for clinical practice and/or further research? Our cases and proposal algorithm could help to determine the treatment options for CSP.

688 - Laparoscopic Management of a Live Caesarean Scar Ectopic

Objective: Demonstration of safe and effective laparoscopic management of a live Caesarean section scar ectopic pregnancy.

687 - Laparoscopic Treatment of Cesarean Scar Pregnancy

Objective: To evaluate the efficacy of laparoscopic surgery in the treatment of cesarean scar ectopic pregnancy compared with other modalities.

724 - Repair of Transmural Isthmocele after Intragestational Methotrexate Therapy for Cesarean Scar Ectopic Pregnancy

Objective: To illustrate the use of robotic surgery in repairing a trans-mural isthmocele following treatment for a cesarean scar ectopic pregnancy.

732 - Robotic Hysterectomy for Cesarean Scar Ectopic Pregnancy

Objective: To present a case of cesarean scar ectopic pregnancy and demonstrate techniques to prevent complications during robot-assisted total laparoscopic hysterectomy, in the face of challenging anatomy.