Cesarean Scar Pregnancy Group Research Articles

Complex Blood Supply Patterns in Cesarean Scar Pregnancy: Insights from Digital Subtraction Angiography Imaging.

BACKGROUND Understanding the blood supply pattern of cesarean scar pregnancy (CSP) can effectively help to determine the best choice of treatment. The aim of this study was to investigate the blood supply pattern and outcomes of patients with CSP through digital subtraction angiography (DSA) imaging. MATERIAL AND METHODS This was a retrospective cohort study. Patients were divided into 2 groups according to the type of CSP. The DSA images of these patients were reviewed, including the type of blood supply, dominant vessel, and collateral blood supply to the gestational sac. The clinical outcomes were analyzed between the 2 groups. RESULTS Thirty-seven patients with type I and 29 patients with type II CSP were enrolled in this study. Type II CSP showed a higher proportion of rich blood supply than type I (44.83% vs 29.72%, P>0.05). Compared with type II CSP, type I CSP tended to have bilateral dominant blood supply predominance (67.57% vs 41.38%, P<0.05). The incidence of collateral blood supply was 5.41% in the type I CSP group and 31.03% in the type II CSP group (P<0.05). In the type II CSP group, multiple collateral blood vessels were found in 4 patients. The superior vesicle artery was the most common source of collateral blood supply in both groups. Two patients with type II CSP suffered massive bleeding during surgery after uterine artery embolization (UAE). None of the patients received a hysterectomy. CONCLUSIONS UAE is safe and effective for both types of CSP. The blood supply pattern is more complex and abnormal in type II CSP. More attention should be paid to the collateral blood supply to achieve complete embolization during the UAE procedure in the case of type II CSP.

Predictability of Hematological Parameters in the Diagnosis of Cesarean Scar Pregnancy.

Introduction Cesarean scar pregnancy (CSP) is an increasing clinical condition that causes serious maternal morbidity and mortality. This study aimed to evaluate if inflammation markers measured by hemogram can aid in the diagnosis of CSP. Materials and Methods A total of 86 patients were included in the study. The cases were divided as CSP ( n : 42) and normal pregnancy (NP) ( n : 44). At the time of admission, peripheral blood neutrophils, lymphocytes, monocytes, thrombocytes, systemic inflammatory index (SII) (neutrophil × platelet/lymphocyte), neutrophil-lymphocyte ratio, monocyte-lymphocyte ratio, and platelet-lymphocyte ratio were all measured. CSP and NP diagnoses were made by transabdominal or vaginal ultrasonography. Results In the CSP group, mean age ( p < 0.001), gravida ( p < 0.001), parity ( p < 0.001), number of surviving children ( p < 0.001), number of abortions ( p < 0.001), cesarean number ( p < .001), dilatation and curettage count ( p = 0.013), monocyte (M) value ( p = 0.039) and monocyte/lymphocyte value (MLR) ( p = 0.035) were significantly higher than the control group. The optimal M value cut-off value was found to be > 0.40, the sensitivity value was 78.57, and the specificity value was 50.00. AUC = 0.632 (SE = 0.061) for the MLR value. The optimal MLR cut-off value was found to be > 0.232, the sensitivity value was 61.90, and the specificity value was 63.64. Conclusion Hemogram parameters, which are simple, inexpensive, and easily accessible, M and MLR are significantly higher in the diagnosis of CSP and can be used as an auxiliary parameter for ultrasonography.

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

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.

Contrast-Enhanced Ultrasound Evaluation of Mifepristone for Treatment of Low-Risk Cesarean Scar Pregnancy.

Purpose The effect of mifepristone for treatment of low-risk cesarean scar pregnancy (CSP) was monitored by contrast-enhanced ultrasound (CEUS). Methods Data were collected from 23 CSP patients with a 10-point risk score <5 (low-risk CSP) and from 23 intrauterine pregnancy (IUP) patients with a scar from a previous cesarean delivery. All patients were prescribed 75 mg mifepristone daily for 2 days and underwent transvaginal CEUS before and after administration of mifepristone. On the third day, uterine curettage was performed after transvaginal CEUS. Arrival time (AT), peak intensity (PI), and area under the curve (AUC) around the gestational sac were monitored by CEUS before and after application of mifepristone, and the rate of effective treatment was compared between the two patient groups. Results No patients experienced side effects from either the CEUS procedure or the mifepristone treatment. Changes in AT, PI, and AUC index from before vs. after mifepristone treatment did not differ significantly between the two groups (all p values >0.05). There was also no significant difference in the rate of effective treatment between the two groups (95.65% in the CSP group vs. 100% in the IUP group; p > 0.05). Conclusions Based on monitoring by CEUS, the effect of mifepristone in low-risk CSP was comparable to that in IUP.

Evaluation of Plasma Free Amino Acid and Carnitine Levels in Patients with Cesarean Scar Pregnancy.

This study aimed to explore the plasma free amino acid (FAA) and carnitine levels in pregnant women with cesarean scar pregnancy (CSP), and to compare them with those of healthy pregnant women. This prospective and randomized controlled study was conducted in patients admitted to Harran University Medical Faculty Hospital Obstetrics Clinic between January 2018 and January 2019. A total of 60 patients were included in the study, and the patients were divided into two groups: the CSP group (n = 30) and the healthy pregnant group as the control group (n = 30). The blood samples were taken from the participants between 7 - 12 weeks of gestation. Twenty-seven carnitines and their esters and 14 FAAs were analysed by liquid chromatography - mass spectrometry (LC-MS/MS). The mean plasma concentrations of some carnitines, including C2, C5, C5-OH, C5-DC, C6, C8-1, C12, C14, C14-1, C14-2, C16, C16-1, C18, and C18-1 were significantly higher in the CSP group than in the control group. However, other carnitines, including C0, C3, C4, C4-DC, C5- 1, C6-DC, C8, C8-DC, C10, C10-1, C18-1-OH, and C18-2, were similar in both groups. The plasma levels of some FAAs, including Methyl Glutaryl, Leu, Met, Phe, Arg, Orn, and Glu values, were significantly higher in the CSP group than in the control group. However, there was no statistical significance in other FAA levels, including Val, Asa, Tyr, Asp, Ala, Cit, and Gly between the two groups. Additionally, Pearson's correlation analysis showed that there were significantly positive correlations between many FAA and carnitine values. Since several plasma carnitines and FAA levels were higher in the CSP group than in the control group, we think that scar pregnancy increases the metabolic need for myometrial invasion. Also, we think that these results may be useful in clinical practice for CSP diagnosis.

The clinical and ultrasound-based comparison between cesarean scar pregnancy and other lower uterine segment pregnancies with a history of cesarean section

Objective: To compare the clinical and ultrasound characteristics of cesarean scar pregnancy (CSP) and other lower uterine segment pregnancies (LUSPs) to enable differential diagnosis of the two pathologies in the first trimester.Methods: A retrospective analysis of early pregnancies with a gestational sac located in the lower uterine segment with cesarean section history in our hospital from December 2011 to February 2018 was performed. According to the diagnoses, the patients were divided into the CSPs group and the other LUSPs group. The clinical and ultrasound features were compared.Results: A total of 38 patients were enrolled with 16 (42.1%) CSPs and 22 (57.9%) other LUSPs. Compared to the other LUSPs group, the CSPs group had thinner lower uterine myometrium (0.16 ± 0.11 cm versus 0.32 ± 0.14 cm, p = .000), larger maximum diameter of the gestational sac (5.14 ± 2.08 cm versus 3.77 ± 1.24 cm, p = .028); the distribution of the villous chorion sites (p = .001) and the main blood supply sites (p = .000) of the gestational sac were different between the two groups. Surgical bleeding volume during the termination of gestation was higher in the CSPs group than in the other LUSPs group (p = .028).Conclusion: Patients with CSPs and other LUSPs have different imaging characteristics on ultrasound. The prognosis of these patients also differs. Ultrasound feature is very useful in the differential diagnosis of these two clinical-mimicking pathologies.

Serum β-human chorionic gonadotropin profile and its correlations with ultrasound parameters in low-lying-implantation ectopic pregnancy in the first trimester.

Cervical pregnancy (CP) and cesarean scar pregnancy (CSP), defined as low-lying-implantation ectopic pregnancy (LLIEP), are rare conditions of aberrant implantation around the lowest portion of the uterus. This study aimed to illustrate the serum β-human chorionic gonadotropin (β-hCG) profile of LLIEP and to explore its implications with the clinical characteristics. Women with LLIEP during the first trimester were retrospectively evaluated at a tertiary referral center from August 1999 to July 2016. Demographic and clinical data were recorded, including maternal age, gestational age (GA), serum β-hCG level, maximal diameter of the gestational mass/sac (MDM/MDS) by ultrasonography and CSP implantation types. The serum β-hCG level was measured on the day of ultrasound imaging. The significance of pretreatment the serum β-hCG level and its correlations with the clinical characteristics were analyzed. A total of 88 LLIEP with 64 CSP and 24 CP was included. The mean GA at the time of diagnosis was 7 weeks (range, 5-12 weeks). The β-hCG concentrations rapidly increased from GA 5 to 9 weeks and fluctuated thereafter. The β-hCG levels correlated positively with GA and ultrasound MDM/MDS. In the CSP group, there was no difference in the β-hCG level between superficial and deep implantation types. β-hCG levels demonstrated no significant differences among simple and complicated LLIEP. This study established the serum β-hCG profile in LLIEP in the first trimester. The exponential increase of β-hCG levels was similar to that of normal intrauterine pregnancies. The β-hCG levels were not associated with placentation complexity of CSP. Higher β-hCG levels did not implicate less success in conservative surgical management.

Low-lying-implantation ectopic pregnancy: A cluster of cesarean scar, cervico-isthmus, and cervical ectopic pregnancies in the first trimester

ObjectiveTo describe the treatment outcomes of aberrant ectopic implantations in the lower segment of the uterus in a cohort population and to evaluate whether or not low-lying-implantation ectopic pregnancy (LLIEP), a new term, is appropriate to include in the traditional diagnoses of cervical pregnancy (CP), cesarean scar pregnancy (CSP), and other unusual aberrant implantations in the lower segment of the uterus in the first trimester, in terms of clinical characteristics, treatment, and prognosis. Materials and methodsForty-two women with ectopic pregnancies of <12 weeks' gestational age from July 2003 to December 2008 were prospectively studied. Each patient underwent an ultrasound evaluation by an experienced consultation team and was grouped into the CP, CSP, or cervico-isthmic pregnancy (CIP) group. Patients underwent either suction dilatation and curettage (D and C) alone, or laparoscopic uterine artery blockage followed by suction D and C, to remove the aberrant trophoblasts without other adjuvant treatments. Clinical characteristics and biochemical factors, including obstetric history, patient age, body mass index (BMI), gestational age, serum hematocrit and β-hCG level, operation method, operation time, and intraoperative blood loss were evaluated. ResultsThere were no significant differences in patient age (mean = 34.1 ± 6.4 years), previous number of cesarean deliveries (mean = 1.5 ± 0.8), gestational age (mean = 6.9 ± 1.2 weeks), serum β-hCG (mean = 35,384.3 ± 41,726.9 mIU/mL), operation time (mean = 60.3 ± 46.6 minutes), and surgical blood loss (mean = 124.7 ± 191.5 mL) among the three patient groups. The uterus was successfully preserved in all patients after treatment. ConclusionThe prognosis of surgical management for ectopic implantations in the lower segment of the uterus is good. The new term LLIEP seems appropriate to cover all forms of aberrant ectopic implantations in the lower segment of the uterus in the first trimester, in terms of treatment efficacy. The use of LLIEP for preoperative ultrasound diagnosis would enable the clinician to diagnose unusual cases more easily, without the need to change the current treatment policy.