Cesarean Section Scar Pregnancy Research Articles

Pregnancy Following Caesarean Section, Managed by Anterior Colpotomy

Caesarean section scar pregnancy is a rare form of ectopic pregnancy which is life-threatening for the mother due to uterine rupture at an early stage of pregnancy and haemorrhage. It is a pathology whose frequency is increasing due to the evolution of the caesarean section rate. We report the case of an isthmoceles pregnancy diagnosed at 9 weeks of amenorrhoea during the first trimester ultrasound.

Vaginal Approach to Cesarean Section Scar Pregnancies: A Standardized 10-step Surgical Procedure

To show a 10-step standardized vaginal surgical technique to treat first trimester C-Section scar pregnancies. Video Article with a stepwise demonstration captured in an Operation Room of a tertiary medical center of a Low-Income country (Bolivia). C-Section scar pregnancies have a wide variety of management options. We present a vaginal surgical approach which has been developed by our group with no observed complications in 6 consecutive cases at the time of this publication. Ten-Step technique: 1.- Patient positioning, 2.- Cervical exposure and traction, 3.- Cervical infiltration with vasoconstrictor solution. 4.- Anterior mucosal incision and dissection of vesicovaginal space, 5.- Identification of vascular pedicle and ligation, 6.- Cold-Knife isthmocele incision and ectopic pregnancy evacuation, 7.- Uterine cavity curettage, 8.- Hysterorraphy with interrupted suture, 9.- Cystoscopy, 10.- Vaginal mucosa closure with running suture. We have used this technique in 6 consecutive patients. Operating time ranged between 20 - 25 minutes. All patients were discharged in postoperative day 1. We prefer surgical options for these patients since it provides both a complete removal of the ectopic pregnancy and repair of the isthmocele. A vaginal approach to such cases has proven to be a safe, simple and fully reproductible technique. We find it applicable for any patient with this pathology but especially suitable for low resource or somehow financially challenged hospitals.

Scarred for life: a review of cesarean section scar pregnancy and potential pitfalls in diagnosis.

Cesarean section scar pregnancy (CSSP) is defined as abnormal implantation of a gestational sac on or in a previous cesarean section scar. There is an increasing incidence of detection of CSSP, likely in part due to the growing rates of cesarean deliveries and the improved rates of detection with advancing ultrasound technology. Diagnosis of CSSP is critical due to the potentially life-threatening complications to the mother if left untreated. Pelvic ultrasound is the imaging modality of choice in the initial evaluation of suspected CSSP, with MRI potentially useful if ultrasound findings are equivocal, or if confirmation is requested prior to definitive intervention. Early and accurate diagnosis of CSSP allows for prompt management to avoid severe complications and the potential to preserve the uterus and future fertility. A combination of medical and surgical treatment strategies may be needed with specific therapy tailored to each patient. Follow-up after treatment should include serial beta-hCG levels and possible repeat imaging if there is clinical concern for complications or treatment failure. This article will provide a comprehensive review of this uncommon but important phenomenon, detailing the pathophysiology and types of CSSP, imaging presentations, potential pitfalls in diagnosis, and management options.

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

Caesarean Scar Pregnancy: Single Dose of Intrasac Ultrasound-Guided Methotrexate Injection Seems to be a Safe Option for Treatment.

The purpose of the study was to assess the efficacy of local ultrasound-guided methotrexate injection in patients with caesarean section scar pregnancy, to chart the course of beta-human chorionic gonadotropin levels (HCG) after treatment, and to see if HCG levels are correlated with clinical presentation. Between May 2018 and January 2021, data were collected retrospectively from the Early Pregnancy Unit of a tertiary hospital. Our clinic assessed 20 patients; one disputed terminating the pregnancy and was not included in the research. The remaining 19 patients, with a median age of 34 years, received intragestational sac methotrexate injection under ultrasound guidance. 7w3d was the median gestational age. These women had one to four previous caesarean sections, with a mean of 1.60±9. Patients with caesarean scar pregnancy most typically presented with spotting (42.1%), whereas 26.3% were asymptomatic. Except in cases of pain, the symptomatic women's HCG levels were lower than in the non-symptomatic women. The level of HCG in patients with pain was approximately double that of non-pain patients (p=0.2557). In our series, intragestational sac methotrexate injection was effective in 17/19 women, or 89.5% (95%CI: 75.7-100%). HCG levels were undetectable in 97.6±30 days on average (minimum: 42 days, maximum: 147 days). Caesarean scar pregnancy is a rare possibly fatal condition with no consensus on the optimal treatment. An experienced Early Pregnancy Unit member performing local methotrexate injections under ultrasound guidance is a feasible and successful strategy in clinically stable patients.

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.

EP40.27: Relevant ultrasonographic findings for timely surgical management of ectopic pregnancy in Caesarean section scar

EP40.27: Relevant ultrasonographic findings for timely surgical management of ectopic pregnancy in Caesarean section scar

Effect Analysis of Three Treatments in Patients with Cesarean Section Scar Pregnancy Complicated by Massive Hemorrhage

Effect Analysis of Three Treatments in Patients with Cesarean Section Scar Pregnancy Complicated by Massive Hemorrhage

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.

Outcomes of pregnancies at high-risk for placenta accreta spectrum following negative diagnostic imaging.

To assess the pretest and negative post-test probability for placenta accreta spectrum (PAS) in a group of patients with high-risk clinical factors. We included patients with suspected and/or confirmed PAS at our institution over 8 years. Sonography performed by maternal-fetal medicine specialists, and selected patients underwent MRI. Imaging was considered positive if either sonography or MRI suggested PAS. Histopathology was the gold standard for diagnosis of PAS. We assessed the pretest and negative imaging-test probability, and resources required. We identified 82 high-risk patients with the following: (1) a history of≥1 cesarean section and/or intrauterine gynecologic procedure and placenta previa in the index pregnancy; (2) a history of >3 cesarean deliveries and/or gynecologic procedures regardless of placental location; (3) prior PAS disorder, or retained placenta requiring manual extraction and/or curettage, complicated by postpartum hemorrhage; and (4) suspected cesarean section scar pregnancy. Histopathology confirmed PAS in 52 patients, with pretest probability of 63%. Imaging correctly identified 44/50 cases with PAS, and excluded this condition in 24/30 cases. Thus, the positive and negative post-test probability for PAS following negative imaging was 88 and 20%, respectively. Of the six patients with false-negative imaging, all had either surgical complications or required care beyond that for routine cesarean section. Although diagnostic imaging is sensitive, the negative posttest probability remains high in women with high pretest probability for PAS. Therefore, women at high risk for PAS should be managed in experienced centers by a multidisciplinary team even if imaging is negative.

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.

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

Clinical efficacy of transvaginal laparoscopic surgery in the treatment of type II cesarean section scar pregnancy and its effect on postoperative rehabilitation.

article: Clinical efficacy of transvaginal laparoscopic surgery in the treatment of type II cesarean section scar pregnancy and its effect on postoperative rehabilitation - Minerva Surgery 2021 October;76(5):482-3 - Minerva Medica - Journals

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.

Hysteroscopic Intact Removal of Angular and Caesarean Scar Pregnancy: A Novel and Markedly Less Invasive Surgical Treatment

Introduction: Ectopic pregnancy is the most common cause of mortality during the first trimester of pregnancy, and intrauterine ectopic pregnancies show significantly higher morbidity and mortality than extrauterine ones. Despite being less invasive, safety and effectiveness of the hysteroscopic treatment are still unclear. Moreover, such approach is not standardized. We aimed to evaluate safety and effectiveness of hysteroscopic intact removal of angular or cesarean section scar pregnancies, defining a novel and markedly less invasive hysteroscopic technique with a 5-mm Bettocchi hysteroscope or a 3.5-mm Versascope hysteroscope. Materials and Methods: Medical records and video archives were reviewed for all the patients with angular or caesarean scar pregnancies treated with hysteroscopic intact removal technique from January 2000 to December 2018 at our Department. Success and complication rates were assessed. Results: Four patients with angular (n = 1) or cesarean scar pregnancy (n = 3) met inclusion criteria. Case #1 was treated with bipolar resectoscope, cases #2 and #3 with 5-mm Bettocchi hysteroscope, and case #4 with 3.5-mm Versascope hysteroscope. Cases #2–4 did not require cervical dilatation. Before hysteroscopic treatment, cases #2–4 underwent unsuccessful medical therapy with multiple-dose methotrexate. Hysteroscopic treatment success rate was 100%, while complication rate was 0%. All patients were treated with a novel technique: hysteroscopic intact removal of angular or cesarean scar pregnancies. Such technique was described step-by-step. Conclusions: Hysteroscopic treatment of angular and cesarean scar pregnancies may be a safe and effective minimally invasive option. The novel technique of hysteroscopic intact removal technique may allow a markedly less invasive approach.

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.

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.

MANAGEMENT OF CESAREAN SCAR ECTOPIC PREGNANCIES. A COHORT STUDY

Cesarean section scar pregnancies (CSP) are a rare form of ectopic pregnancy occurring in approximately 6% of patients with history of an ectopic pregnancy and cesarean scar. Overall, the prevalence is estimated at 1:1800 to 1:2200 pregnancies. CSPs develop outside the endometrial cavity in the caesarean scar and can be classified as type 1 (growth towards uterine cavity) or type 2 (pregnancy growth toward uterine serosa and abdomen). Primary treatments described include systemic single or multi-dose methotrexate (+/- intra-gestational KCl injection); dilation and curettage (D&C); adjunctive uterine artery embolization; hysteroscopic, transvaginal, laparoscopic or open resection; and hysterectomy.