Cesarean Scar Ectopic Pregnancy Research Articles

Outcome Reporting in Studies Investigating Treatment for Caesarean Scar Ectopic Pregnancy: A Systematic Review.

Caesarean scar ectopic pregnancy (CSEP) is associated with significant maternal and foetal morbidity. However, the optimal treatment remains unknown. The aim of this study was to review outcomes reported in studies on CSEP treatment and outcome reporting quality. We reviewed 1270 articles identified through searching PubMed, MEDLINE and Google Scholar from 2014 to 2024 using the search terms 'caesarean scar ectopic pregnancy and caesarean scar pregnancy'. We included all study types evaluating any form of CSEP treatment, with a sample size of ≥ 50, where diagnosis was described, and the article was in English. Two authors independently reviewed studies and assessed outcome reporting and methodological quality. The relationship between outcome reporting quality and publication year and journal type was assessed with univariate and bivariate models. A total of 108 studies, including 17 941 women, were included. 83% of all studies originated from China. Studies reported on 326 outcomes; blood loss (86%), need for additional intervention (77%) and time for serum hCG to normalise post treatment (69%) were the most common outcomes. A primary outcome was clearly defined in 11 (10%) studies. The median quality of outcome reporting was 3 (IQR 3-4). No relationship was demonstrated between outcome reporting quality and publication year (p = 0.116) or journal type (p = 0.503). This review demonstrates that there is a wide variation in outcomes reported in studies on CSEP treatment. Development and implementation of a core outcome set by international stakeholders which includes patients is urgently needed to enable high-quality research that is both useful and relevant to patients.

Stepwise Approach to Laparoscopic Hysterectomy for Cesarean Scar Ectopic Pregnancy at 13 Weeks Gestation

Stepwise Approach to Laparoscopic Hysterectomy for Cesarean Scar Ectopic Pregnancy at 13 Weeks Gestation

11906 Systematic Surgical Approach to Cesarean Scar Ectopic Pregnancy in 5 Steps

11906 Systematic Surgical Approach to Cesarean Scar Ectopic Pregnancy in 5 Steps

Understanding and Managing Caesarean Scar Ectopic Pregnancy: A Retrospective Analysis of Risk Factors, Strategies, and Outcomes

Objective: Caesarean Scar Ectopic Pregnancies (CSEP) pose distinct diagnostic and management challenges. This study investigates the risk factors, treatment options, and outcomes for CSEP cases treated at Prince Sultan Medical Military City, Riyadh. Methods: Over a two-year period, medical records of 28 patients with CSEP were reviewed, collecting data on patient demographics, obstetric history, and treatment outcomes. This analysis aimed to identify influential risk factors and assess the effectiveness of various management strategies. Results: Treatment success was achieved in 85.7% of cases, with Methotrexate (MTX) proving effective in over half of the cases. The findings suggest significant risk factors and best practices for managing this rare condition. Conclusion: Early detection, risk factor awareness, and tailored treatment strategies are key to optimizing outcomes in patients with CSEP.

Outcome and treatment of cesarean scar ectopic pregnancy under ultrasound-guided vacuum aspiration.

This study aimed to describe cases of cesarean scar pregnancies that were successfully treated with suction curettage under ultrasound guidance and their outcome. This retrospective, descriptive case-series study was performed on 17 patients diagnosed with cesarean scar ectopic pregnancy in Sulaimani Maternity Teaching Hospital from May 2022 to April 2023. The patients' sociodemographic and clinical data were collected. The patients were treated with suction curettage alone or in combination with local injection of methotrexate under ultrasound guidance. Patients with a viable fetus (n = 4) received local intrinsic methotrexate injection into the gestational sac and suction curettage, while those in whom the fetus had died (n = 13) underwent only suction curettage. Five patients required intrauterine balloon insertion to stop bleeding without further treatment, and only three required a blood transfusion owing to severe bleeding. Cesarean scar ectopic pregnancy is a dangerous and complex disorder with an increasing occurrence in recent years. Accurate early diagnosis and effective management are essential to reduce maternal mortality and mortality of this type of pregnancy.

A Case Report of Rupture of Anterior Uterine Wall due to Cesarean Scar Ectopic Pregnancy

A Case Report of Rupture of Anterior Uterine Wall due to Cesarean Scar Ectopic Pregnancy

Imaging in early diagnosis of caesarean scar ectopic pregnancy: A case report

Imaging in early diagnosis of caesarean scar ectopic pregnancy: A case report

Objective Analysis of Predictive Value of Ultrasound Quantitative Scoring System for Treatment Method Selection in Cesarean Scar Pregnancy.

This study aimed to explore the feasibility of using the ultrasound quantitative scoring system to guide the selection of surgical methods for a cesarean scar ectopic pregnancy (CSEP). A retrospective analysis was conducted of the medical records of 117 cases of patients with a CSEP. All patients underwent transvaginal ultrasound examination before treatment, and the ultrasound results were compared with the results of surgical exploration. The treatment methods that were delivered for the 2 patient groups with CSEP were analyzed, and agreement between the predicted and actual treatment protocols was tested using the kappa consistency test. Residual myometrial thickness at the scar site was mainly concentrated above 3 mm in the low-risk group, with 70 cases accounting for 76.9%, while in the high-risk group, this was primarily in the range of 1-3 mm with 18 cases accounting for 69.2%. The grading of nourishing blood supply to the gestational sac showed that 96.7% of patients in the low-risk group had Grade I and Grade II blood flow, while 84.6% of the high-risk group had Grade I and Grade II blood flow; Grade II blood flow was predominant in the high-risk group. The majority of patients in both the low- and high-risk groups experienced intraoperative blood loss of ≤50 mL (93.9% vs 80.6%, respectively). The consistency test between the actual and predicted treatment methods yielded a kappa coefficient of 0.644, indicating consistency between the two. For patients with CSEP in the low-risk group (score <4), the ultrasound quantitative scoring system could provide individualized assessment and offer clinically valuable treatment protocols.

Treatment of Cesarean Scar Ectopic Pregnancy Using a Double Balloon System

Cesarean scar pregnancies are increasing in incidence, with ill-defined management options. We applied a newly published cesarean scar ectopic pregnancy clinical classification system to our previously published, now expanded, case series of cervical double-balloon catheter management to inform this option as a potential surgical treatment strategy. We found that cervical double-balloon catheter management of cesarean scar pregnancies is an efficacious and safe option when utilizing the newly published clinical classification system. Of our 34 recorded cases, only 5.9% (2/34) of patients required additional procedures after initial cervical double-balloon catheter. Cervical double-balloon catheter should be considered as potential management in future classification systems.

A Series of Cesarean Scar Ectopic Pregnancies: Unusual Presentations with Customized Management Pathways

A Series of Cesarean Scar Ectopic Pregnancies: Unusual Presentations with Customized Management Pathways

Cesarean Scar Ectopic Pregnancy: A Do-Not-Miss Diagnosis.

The rate of cesarean section (CS) for delivery has increased internationally, reaching 50% in some countries. Abnormal implantation of a new pregnancy at the site of the prior hysterotomy is an important complication because of the risks of hemorrhage, uterine rupture, and progression to placenta accreta spectrum (PAS), a condition with high morbidity with potential for catastrophic obstetric hemorrhage, maternal and fetal mortality, and loss of fertility. Cesarean scar ectopic pregnancy (CSEP) is the recommended term to describe these pregnancies, which are recognized on the basis of the sac implantation site, growth pattern, and associated abnormal perfusion. The true incidence of CSEP is unknown because the condition is likely underdiagnosed and underreported. The 2022 Society for Maternal-Fetal Medicine consult series notes that severe maternal morbidity and mortality are linked to difficulty in making the diagnosis of CSEP. The authors review the signs of CSEP at imaging, some pitfalls that may lead to delayed or missed diagnosis, and the consequences thereof. CSEPs must be differentiated from low implantation of a normal pregnancy, cervical ectopic pregnancy, and evolving pregnancy loss. Early recognition allows prompt and safe treatment that is usually surgical. Early treatment results in decreased health care costs, a shorter hospital stay, preservation of fertility, and prevention of iatrogenic preterm delivery, which is typical in cases that progress to PAS. Hysterectomy has serious negative psychologic consequences for patients of childbearing age; early diagnosis and prompt treatment of CSEP can prevent this often-ignored complication. ©RSNA, 2024 Supplemental material is available for this article.

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

To describe an effective two-step surgical approach for the management of cesarean scar ectopic pregnancies (CSEPs). CSEPs occur at an estimated frequency of 1 in 1,800 pregnancies, constituting approximately 6% of ectopic pregnancies in women with a history of prior cesarean delivery [1, 2]. Despite numerous recommended therapeutic approaches, the most effective treatment strategy remains uncertain [3]. We present an innovative double-step technique for the management of a patient with a CSEP involving hysteroscopic subchorionic injection of methotrexate (MTX), followed by laparoscopic resection of the residual gestational sac and simultaneous repair of the uterine defect. Academic tertiary hospital. A 34-year-old G2P1001 with a history of prior cesarean section presented at 10 weeks of gestation. Ultrasound revealed a gestational sac within the niche of the previous cesarean scar, confirming the diagnosis of a CSEP. The patient included in this video gave consent for publication of the video and posting of the video online, including on social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, and Scopus, among others), and other applicable sites. The initial treatment involved hysteroscopic administration of MTX within the placental intervillous spaces, ensuring precise medication delivery. The administered dose of MTX was 1 mg/kg. Following the normalization of beta-human chorionic gonadotrophin (β-hCG) levels, laparoscopic resection of the remaining gestational sac and reconstruction of the uterine wall defect were performed. We have implemented a management strategy focusing on ectopic pregnancy removal and addressing defect revision. The hysteroscopic approach allows for a clear assessment of the ectopic pregnancy and facilitates precise MTX administration, enhancing its effectiveness by increasing drug concentration within the placental intervillous space. Delaying surgical repair until after the β-hCG levels have decreased reduces the risk of excessive bleeding during the procedure, as lower β-hCG levels are associated with reduced vascularity at the ectopic site. Subsequent laparoscopic resection allows for complete removal of the remaining products of conception and repair of the defect, preserving the uterus and restoring normal anatomy. Compared to other surgical approaches,our two-step approach enables a more precise evaluation of placental implantation, making it a highly effective surgical method. We successfully managed a CSEP using a double-step technique. This involved hysteroscopic injection of subchorionic MTX, followed by laparoscopic resection of the residual gestational sac. Concurrently, we repaired the uterine defect. Both procedures were performed in an outpatient setting without complications detected during or after treatment. At the follow-up visit, the patient reported good health, and subsequent ultrasound confirmed an empty isthmocele. This sequential hysteroscopic and laparoscopic approach represents a definitive and effective minimally invasive surgical option for the treatment of CSEP.

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 &amp; 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&amp; 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 &amp; 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.