Cesarean Section Scar Ectopic Pregnancy Research Articles

Rare Cesarean Section Scar Ectopic Pregnancy Successfully Treated by Methotrexate: A Case Report

An ectopic pregnancy embedded in a C-section scar is considered an uncommon and complex sub-type of ectopic pregnancy. This particular condition requires an increased level of clinical suspicion, the use of specific diagnostic tools, and the implementation of customized care measures. Here we present a case of a 37-year-old lady with a history of 3 C-sections presented to the ER department with an acute attack of pain and vaginal bleeding for 1 hour before admission on day 19 of a regular cycle. She gave a six-month history of intermenstrual bleeding and chronic pelvic pain. Her previous bacteriological and pap smears were normal. An earlier pelvic scan showed an Rt ovarian case, a thickened endometrium, and a small mural fibroid. Upon admission, B-HCG was positive; transvaginal ultrasound was negative. B-HCG titers confirmed the EP, and an MRI scan confirmed CsEP. She was managed medically with methotrexate and showed a good response. Clinicians must exercise diligence in evaluating patients with a prior history of cesarean sections and who are currently experiencing symptoms of pelvic pain and irregular uterine bleeding. The timely identification and intervention of this complex ailment are crucial to minimize the potential hazards involved and optimize the patient's overall prognosis.

A RARE CASE REPORT: CAESAREAN SCAR ECTOPIC PREGNANCY - MEDICAL MANAGEMENT.

Caesarean section scar ectopic pregnancy (SEP) is a rarest form of ectopic pregnancy. If not diagnosed and adequately treated in early pregnancy leads to considerable maternal morbidity and mortality. With the increasing rate of caesarean section there is a substantial increase in this condition with better understanding of this disease. Caesarean scar ectopic is the implantation of a gestational sac in the myometrium and brous tissues at the site of a previous uterine scar (mostly cesarean section scar). We describe the presentation, workup including radiology studies and management of a caesarean scar ectopic pregnancy in a 23 yrs. old gravida 4 para1 living 1 with 2 abortions with previous one caesarean section. The mean gestational age at the time of diagnosis was 7w 5d. The majority of the women presented with either pain or bleeding, but few cases were asymptomatic and were diagnosed with scar ectopic pregnancy during routine obstetric ultrasonography. We were successful in treating this rare form of ectopic pregnancy without any maternal morbidity and with medical management.

Caesarean Section Scar Ectopic Pregnancy: A Case Report

Background Cesarean section scar ectopic pregnancy is recognized rare pregnancy complication which occurring in the myometrium of a previous scar of cesarean delivery with estimated rate one in 2000 pregnancies. Various management modalities for CSEP depend on the case presentation ranges from expectant or conservative management, medically with methotrexate, or surgical excision by hysteroscopy or laparoscopy or laparotomy, vacuum aspiration can be used to remove the ectopic scar. Methods And Patient A case report of caesarean section scar ectopic pregnancy presented at obstetrics and gynecology department in Tripoli university hospital on 5th September 2022, which experience profuse vaginal bleeding, drowsy, pallor her hemoglobin concentration was 7.6 g/dl and Beta HCG at admission was 5664 mIU/ml with history of insufficient antenatal care compliance on current pregnancy that confused the diagnosis of CSSEP for incomplete abortion. The patient undergone individual management and follow up till became significantly heath condition improved either clinically or laboratory Comments The cesarean scar ectopic pregnancy is considered as a rare type of ectopic pregnancy with difficult diagnosis and individual management according to health situation at presentation. Therefore, early recognition and proper assessment of CSEP is critical to achieve adequate management and to reduce related maternal morbidity and mortality

8557 Laparoscopic Resection of Involuting Cesarean Scar Pregnancy after Failed Multidose Methotrexate and KCl Treatment

<h3>Study Objective</h3> To describe the workup, treatment, and follow up of a cesarean-section scar ectopic pregnancy (CSP) that failed medical management and to demonstrate a laparoscopic resection of a cesarean section scar ectopic pregnancy that has failed medical management. <h3>Design</h3> Surgical video. <h3>Setting</h3> An academic teaching hospital and tertiary care center. <h3>Patients or Participants</h3> 36-year-old G2P2022, with a persistent cesarean scar ectopic pregnancy, who failed medical management with a multi-dose Methotrexate protocol and intrasac KCl injection and presented 3 months later for infertility evaluation. <h3>Interventions</h3> After failing medical management, the patient consented for a laparoscopic resection of CSP with revision of the previous scar. During surgery, the patient was found to have an involuting ectopic pregnancy at the site of the previous scar, which was successfully resected. The uterine incision was repaired in two layers. <h3>Measurements and Main Results</h3> The laparoscopic repair was completed successfully. Pathology showed fibrotic and necrotic chorionic villi with an adjacent decidual reaction consistent with a pregnancy. The patient's beta-hcg trended down to non-pregnant levels and she had a normal postoperative visit with no concerns. <h3>Conclusion</h3> Recommended treatment for CSP includes surgical resection, as medical management alone is unlikely to be successful. Key strategies for laparoscopic excision include use of backfilling the bladder to delineate borders, avoidance of excessive thermal energy, and closure of the defect in multiple layers.

Cesarean Section Scar Ectopic Pregnancy: A Case Report and Literature Review

Scar pregnancy is a rare but serious form of ectopic pregnancy that is life-threatening and functional. Its actual incidence remains undetermined, but the increase in published cases over the past ten years testifies to the increased vigilance of obstetrician-gynecologists on ultrasound diagnosis, which remains the first-line examination. To date, there is no consensus on a reference treatment. We report our experience of a case of pregnancy on caesarean section scar in a 36-year-old patient treated in our department. The diagnosis was suspected in the presence of metrorrhagia associated with pelvic pain in the first trimester of pregnancy. Ultrasound confirmed the diagnosis and treatment consisted of surgical cure by laparotomy. The objective was to discuss the epidemiological, physiopathological, diagnostic aspects, the therapeutic and evolutionary modalities of this rare pathology.

Cesarean Scar Pregnancy: Report of Two Cases

Cesarean section scar ectopic pregnancy is rare pregnancy complication. They have become common due to an increase in cesarean sections worldwide. The following report outlines two cases of scar pregnancy in women; both women had a history of two previous cesarean sections. Both were type 2 scar pregnancies as they protruded from the uterine myometrium towards the uterine serosa.1 The first woman initially received suction evacuation. The products, however, could not be entirely evacuated. As a result, laparotomy was performed. The second patient also underwent laparotomy due to her symptoms. Obstetricians need to keep a high index of suspicion while managing women with risk factors for an ectopic scar pregnancy. Failure to detect and pledge rapid treatment can lead to uterine rupture, massive hemorrhage, and maternal death. In the following report, presentations, and management of these two cases are discussed followed by a review of published literature.

Fertility-Preserving Surgical Management of a Cesarean Section Scar Ectopic Pregnancy

To demonstrate techniques used for fertility-preserving surgical management of a cesarean scar ectopic pregnancy. A narrated video case report demonstrating techniques and surgical approach. With the increasing number of cesarean deliveries being performed, cesarean scar ectopic pregnancies (CSEP) have an increasing incidence affecting approximately 1 in 2000 pregnancies. CSEP can be associated with serious complications, which include maternal hemorrhage, uterine rupture, and even maternal death. This video highlights a case presentation of a 28-year-old G6P4014 with a history of 4 previous cesarean deliveries who presented with a persistent cesarean scar ectopic pregnancy that had failed previous medical management. This video highlights the techniques that allow for fertility-preservation with restoration of normal anatomy as well as minimizing blood loss with a potentially morbid procedure. Techniques used to allow for fertility preservation with restoration of normal anatomy: 1. Utilization of avascular spaces and identification of critical structures to restore anatomy that is often distorted by the CSEP. 2. Limited use of electrosurgery to allow for adequate postoperative healing. 3. Identification of the endometrial cavity to allow for complete removal of the CSEP and isthmocele repair. Techniques used to minimize blood loss: 1. Intracervical injection of dilute vasopressin. 2. Intrauterine injection of dilute vasopressin (20U in 60 cc of injectable saline). 3. Temporary occlusion of bilateral gonadal vessels using surgical clips. The surgical techniques highlighted in this video allow for the surgical removal of a cesarean scar ectopic pregnancy with concurrent repair of the uterine defect, allowing for restoration of normal anatomy. This is a safe and feasible fertility-preserving option that can be performed using a minimally-invasive approach.

Robotic Assisted Laparoscopic Resection of a Cesarean Section Scar Ectopic Pregnancy

Study Objective Demonstrate the removal of a cesarean section scar ectopic pregnancy performed robotically. Design Video Demonstration. Setting Operating Room. Patients or Participants One. Interventions Uterine artery embolization was performed prior to surgery. Measurements and Main Results Cesarean section scar ectopic pregnancy was resected with minimal blood loss in a minimally invasive surgery. Conclusion Resection of a cesarean section scar ectopic pregnancy was safely performed after uterine artery embolization using robotic assisted laparoscopy. Demonstrate the removal of a cesarean section scar ectopic pregnancy performed robotically. Video Demonstration. Operating Room. One. Uterine artery embolization was performed prior to surgery. Cesarean section scar ectopic pregnancy was resected with minimal blood loss in a minimally invasive surgery. Resection of a cesarean section scar ectopic pregnancy was safely performed after uterine artery embolization using robotic assisted laparoscopy.

The Challenge of the Non-Compliant Patient: A Case of Caesarean Section Scar Ectopic Pregnancy

Ectopic pregnancy is a quite common and life-threatening pregnancy. The most common site of ectopic implantation of a fertilized embryo is the fallopian tube. In extremely rare situations, the embryo can implant in other locations, which makes the diagnosis and management even more complex. Although close observation of a new pregnancy is key in the diagnosis and treatment of an ectopic pregnancy, there is still a major risk of life-threatening outcomes. This is a case report of a 31-year-old patient with a history of multiple pregnancies who presented to a community hospital in the spring of 2021 with an ectopic caesarean scar pregnancy. A diagnosis of ectopic pregnancy was on a timely basis, and surgical management was advised. Upon refusal of treatment and admission, pharmacological management was initiated, but patient compliance challenged the success of the therapy. Patient non-compliance to close follow-up resulted in a ruptured uterus. Emergency laparotomy with supracervical hysterectomy was performed as a life-saving procedure.

A rare Case of Cesarean Section Scar Ectopic Pregnancy Managed by Laparotomy

Cesarean section scar ectopic pregnancy (CSEP) is defined as a pregnancy in which blastocyst is implanted within the scar of previous cesarean section. It is a rare form of ectopic but its frequency is increasing due to increasing rate of cesarean section. In this case, a 36 years old G3P2A0, married for 10 years, previous II C/Sections, LCB 7 years back, presented with ultrasound report of the viable pregnancy at 11+1 weeks with gestational sac incorporating into previous scar of cesarean section. She was otherwise asymptomatic and stable. Serum Beta hCG was 73664.78 IU/L. Laparotomy was done as an elective procedure. Dense adhesions were noted on opening the abdomen between anterior abdominal wall, uterus, bladder and gut. Scar ectopic pregnancy was excised after dissecting the adhesions. Her Serum Beta hCG 48 hour post-operatively was 1397.0 IU/L.Patient was discharged home on 2nd post-operative day in good condition. She was counselled about risk of a recurrent scar ectopic and rupture of uterus in next pregnancy. Her serum Beta hCG declined to normal by 4 weeks post operatively. Keywords: Cesarean section, scar ectopic, laparotomy

Caesarean Section Scar Ectopic Pregnancy Presenting with Uterine Rupture: A Rare Case Report

Caesarean scar ectopic pregnancy is a rare form of pregnancy implanting on a caesarean scar and is considered a gynaecological emergency associated with scar rupture and increased incidence of maternal morbidity when complicated with haemorrhage. Scar pregnancy incidence being more common as there are increased caesarean deliveries nowadays. Here the authors present a case of 28-year-old female with caesarean section scar ectopic pregnancy with ruptured uterine scar and haemorrhage associated with haemodynamic collapse which has poor prognosis. Imaging plays a crucial role in early detection and helps the clinician in further management to reduce maternal morbidity and mortality.

Caesarean Section Scar Ectopic Pregnancy Presenting with Uterine Rupture: A Rare Case Report

Caesarean scar ectopic pregnancy is a rare form of pregnancy implanting on a caesarean scar and is considered a gynaecological emergency associated with scar rupture and increased incidence of maternal morbidity when complicated with haemorrhage. Scar pregnancy incidence being more common as there are increased caesarean deliveries nowadays. Here the authors present a case of 28-year-old female with caesarean section scar ectopic pregnancy with ruptured uterine scar and haemorrhage associated with haemodynamic collapse which has poor prognosis. Imaging plays a crucial role in early detection and helps the clinician in further management to reduce maternal morbidity and mortality.

Robotic CSP Resection and Hysterotomy Repair

To demonstrate a technique for the robot-assisted laparoscopic surgical management of cesarean section scar ectopic pregnancy (CSP) and hysterotomy repair. Step-by-step presentation of the procedure using video. CSP is a rare form of ectopic pregnancy. The incidence of CSP has been increasing with rising cesarean deliveries and is estimated to range from 1 of 1800 to 1 of 2500 of all pregnancies. Various management of CSP have been used such as systemic or local methotrexate, surgical resection, and uterine artery chemoembolization. Exogenic or deep CSP occurs when the gestational sac is deeply embedded in the scar and the surrounding myometrium and grows toward the bladder. Surgical resection of this type of CSP seemed reasonable, which could shorten hospitalization and follow-up time and reduce the failure rate of treatment. For its magnification of the 3-dimensional laparoscope, flexibility endo-wrist, and stabilization of instruments within the surgical field, robot-assisted laparoscopic resection can be performed to manage this type of complex procedure. In this video, we describe our technique for robot-assisted laparoscopic management of a CSP and a hysterotomy repair. We present the case of a 34-year-old gravida 2 para 1 woman with the finding of a 7-week pregnancy embedded in the cesarean section scar. The patient had undergone 1 previous uncomplicated cesarean section at term. On presentation, her β-human chorionic gonadotropin level was 9212 IU/L. In this case, the gestational sac was deeply embedded in the scar and the surrounding myometrium and was growing toward the bladder. A decision was made to proceed with surgical treatment in the form of a robot-assisted laparoscopic resection of the ectopic pregnancy and the hysterotomy repair. The surgery was uneventful, and the patient was discharged home within 48 hours of her procedure. No residual scar defect was visible on follow-up ultrasonography 1 month after surgery. Forty days after surgery, the patient had resumed normal menstruation and was followed up for 3 years with regular menstruation and no abnormal uterine bleeding. Robot-assisted laparoscopic excision of CSP and hysterotomy repair is an effective procedure for the management of this increasingly more common condition. The use of a cervix dilator and robot-assisted laparoscopic suturing can prevent hemorrhage and peripheral tissue damage and allow for the safe removal of the ectopic pregnancy with multilayer repair of the uterine defect.

A Strategic Approach to a Total Laparoscopic Hysterectomy for an Advanced Cesarean Section Scar Ectopic Pregnancy with Cystotomy Repair.

Study Objective Present an interesting case of an advanced cesarean scar ectopic pregnancy that failed medical management and underwent treatment with a total laparoscopic hysterectomy. Design Video Case Report. Setting Tertiary Referral Hospital at a community-based OB/GYN residency program. Patients or Participants 37-year-old G3P3013 at 9 weeks gestation with a cesarean scar ectopic pregnancy. Interventions This video will present an interesting case of a 37yo G5P3013 that presented with a 9-week cesarean scar ectopic pregnancy. Initial treatment was with injection of KCL into the fetal heart and methotrexate into the gestational sac at 10 weeks gestation. The patient presented 5 weeks after initial treatment with persistent pain and vaginal bleeding. The patient was the thoroughly counseled on her treatment options. She had no desire for future pregnancy and the plan was made for total laparoscopic hysterectomy with bilateral salpingectomy. This video presentation shows how as strategic anatomic approach using isolation of the blood supply and utilizing avascular spaces can allow this case to be completed in a minimally invasive fashion. This case will also present the steps to repairing an incidental cystotomy that was encountered in the dissection Measurements and Main Results N/A Conclusion Advanced cesarean scar ectopic pregnancy can be treated in a minimally invasive fashion with total laparoscopic hysterectomy when future fertility is not desired.

Cesarean Section Scar Ectopic: Laparoscopic and Hysteroscopic Surgical Management

Study Objective To present a case of resection of cesarean section scar ectopic pregnancy with isthmocele repair using both laparoscopic and hysteroscopic techniques. Design N/A Setting Patient was positioned in the standard dorsal lithotomy position. Throughout the entirety of the video the patient is in Trendelenburg position. Patients or Participants A 25 yo G7P3124 who was diagnosed with a c-section scar ectopic pregnancy via 5w4d ultrasound after presenting with vaginal bleeding and abdominal pain. After being counseled on options for medical versus surgical management, she was initially treated with a dose of methotrexate. Upon further discussion the patient was transferred and opted for surgical management. Interventions In anticipation of potential significant blood loss, a laparoscopic tourniquet was placed at the lower uterine segment and the uterine arteries were skeletonized for easy ligation. A bladder flap was made at the level the vesicouterine peritoneum. The ectopic products of conception were removed hysteroscopically. The isthmocele was then resected and repaired laparoscopically. Finally, hysteroscopic inspection was used to confirm normal contour of the uterus and isthmocele repair. Measurements and Main Results Our patient underwent uncomplicated laparoscopic and hysteroscopic resection of cesarean section scar ectopic with isthmocele repair with minimal blood loss. She was discharged from PACU and was doing well at one week follow up. Conclusion There is currently no standard of care for management of cesarean section scar ectopic. When opting for surgical management it is important to anticipate possible complications, including dense adhesions and hemorrhage. In this video we provide a detailed combined hysteroscopic and laparoscopic approach to removal of cesarean scar ectopic. Techniques to minimize blood loss and reduce injury to surrounding organs are highlighted; including bladder distension, laparoscopic tourniquet, and uterine artery skeletonization. Anticipating and mitigating potential complications with these techniques leads to an optimal outcome.

Honeycomb Decidual Pattern of the Endometrium in a Patient with Cesarean Section Scar Ectopic Pregnancy: An Unusual Presentation of a Physiologic Process

Decidualization of the endometrium is a complex physiologic process that occurs in preparation for implantation of the blastocyst [1,2]. In humans, the trophoblast invasion extends up to the junctional zone located in the inner third of the myometrium [3]. Endometrial decidualization is a global hormonal process that occurs as a consequence of progesterone production by the corpus luteum that precedes the arrival of the blastocyst [4]. These changes also occur in the case of an ectopic pregnancy.

Cesarean section scar ectopic pregnancy - a management conundrum: a\xa0case report

BackgroundCesarean section scar ectopic pregnancies are a rare complication of pregnancy that may follow previous hysterotomy for any cause, uterine manipulation, and in vitro fertilization. It has become more common with the increasing number of cesarean sections worldwide. Fortunately, the use of first-trimester ultrasound imaging has led to a significant number of these pregnancies being diagnosed and managed early.Case presentationWe report a case of a 36-year-old black African patient who had two previous cesarean sections and one previous surgical evacuation. She presented with a type 2 cesarean section scar ectopic pregnancy that was suspected on the basis of transvaginal ultrasound imaging, but not at laparoscopy/hysteroscopy. A bladder adherent to the upper segment of the anterior uterine wall obscured the gestational mass at laparoscopy. There were extensive intracavitary adhesions that interfered with hysteroscopic visualization. This resulted in the original operative procedure being postponed until magnetic resonance imaging confirmed the ectopic location of the pregnancy. The ectopic gestation was subsequently excised, and the uterus was repaired via laparotomy.ConclusionsIt is important for clinicians and radiologists managing women with risk factors for a scar ectopic pregnancy to maintain a high index of suspicion during follow-up. Failure to diagnose and initiate prompt management may lead to uterine rupture, massive hemorrhage, and maternal death.

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.

289 - Combined Hysteroscopic and Laparoscopic Repair of Isthmocele

Combined Hysteroscopic and Laparoscopic Repair of Isthmocele presents a rare case of isthmocele diagnosed after cesarean section scar ectopic pregnancy treated successfully with methotrexate and uterine artery embolisation. Patient was advised against future pregnancies. After MRI and SIS confirmation, video demonstrates combined hysteroscopic approach - transillumination and laparoscopic excision and repair of the isthmocele. We also emphasize the importance of different techniques for decreasing blood loss - tourniquet and vasopressin administration. Defect was repaired with multilayer closure, including final imbricating baseball stitch technique.Following the repair, hysteroscopy was repeated demonstrating resolution of the defect.

Laparoscopic Resection of Cesarean Scar Ectopic Pregnancy

Study ObjectiveTo demonstrate a technique for the laparoscopic surgical management of cesarean section scar ectopic pregnancy. DesignStep-by-step presentation of the procedure using video (Canadian Task Force classification III). SettingCesarean section scar ectopic pregnancy is a rare form of ectopic pregnancy with an incidence ranging from 1:1800 to 1:2216. Over the last decade, the incidence seems to be on the rise with increasing rates of cesarean deliveries and early use of Doppler ultrasound. These pregnancies can lead to life-threatening hemorrhage, uterine rupture, and hysterectomy if not managed promptly. Local or systemic methotrexate therapy has been used successfully but can result in prolonged hospitalization, requires long-term follow-up, and in some cases treatment can fail. In the hands of a trained operator, laparoscopic resection can be performed to manage this type of pregnancy. PatientConsent was obtained from the patient, and exemption was granted from the local Internal Review Board (The Womens' Hospital, Parkville). Interventions, Measurements and Main ResultsIn this video we describe our technique for laparoscopic management of a cesarean scar ectopic pregnancy. We present the case of a 34-year-old G4P2T1 with the finding of a live 8-week pregnancy embedded in the cesarean section scar. The patient had undergone 2 previous uncomplicated cesarean sections at term. On presentation her β-human chorionic gonadotropin (β-hCG) level was 52 405 IU/L. She was initially managed with an intragestational sac injection of potassium chloride and methotrexate, followed by 4 doses of intramuscular methotrexate. Despite these conservative measures, the level of β-hCG did not adequately fall and an ultrasound showed a persistent 4-cm mass. A decision was made to proceed with surgical treatment in the form of a laparoscopic resection of the ectopic pregnancy. The surgery was uneventful, and the patient was discharged home within 24 hours of her procedure. Her serial β-hCG levels were followed until complete resolution. ConclusionLaparoscopic excision of cesarean section scar ectopic pregnancy is an effective procedure for the management of this increasingly more common condition. The use of vasopressin intraoperatively and laparoscopic suturing can prevent hemorrhage and allow for the safe removal of the ectopic pregnancy with multilayer repair of the uterine defect.