Incidence Of Cesarean Scar Pregnancy Research Articles

Early diagnosis of caesarean scar pregnancy by ultrasound - a novel, simple and rapid clinical classification scoring system.

In the recent years, with the increase in the caesarean section rate, the incidence of caesarean scar pregnancy (CSP) has shown a significant upwards trend. We propose a novel, simple and rapid clinical and ultrasound (US) classification scoring system to assist in the early diagnosis of CSP. A total of 385 patients with CSP were included in the study. All patients were given a comprehensive score, iincluding clinical data (whether HCG is consistent with gestational age and vaginal bleeding) and US findings (linea a and b, gestational sac morphology, the presence of primitive cardiac tube beat, and color Doppler aspect). The scores were analysed by ROC curve analysis, and sensitivity and specificity were calculated. A score of 4 has a specificity of 91.7% and a sensitivity of 95.6% in diagnose CSP. The area under the ROC curve was 0.973. This scoring system may be a reliable tool for the early diagnosis of CSP and has the characteristics of being simple and rapid. For patients with a total score of ≥4 points, CSP is suggested, and early clinical treatment can be carried out, while patients with a score of less than 4 points can temporarily retain pregnancy and be closely followed up.

Ruptured Cesarean Scar Pregnancy: A Case Report

Ectopic pregnancy is defined as implantation outside the uterine cavity with an incidence rate of 19 per 1000 conceptions in the United States, accounting for >64,400 hospitalizations annually. It is the leading cause of maternal death in the first trimester. Most ectopic pregnancies (98%) occur in the fallopian tube but can also occur elsewhere. Cesarean scar pregnancy is a form of ectopic implantation in the fibrous tissue around the scar of previous cesarean delivery. The first case of cesarean scar pregnancy was described by Larsen and Solomon in 1978, and only 19 cases were reported until 2001. 3 The incidence of cesarean scar pregnancy is estimated to be 1:1800 to 1:2216 pregnancies. This condition represents 6.1% of all ectopic pregnancies with a history of at least one cesarean operation. In Indonesia, this case is rarely reported, and there is no data on the prevalence of this disease in Indonesia. Due to its rarity, we report a case of a 37-year-old G2P0100 woman with ruptured cesarean scar pregnancy.

Global variation and outcomes of expectant management of CSP.

The incidence of Cesarean scar pregnancies (CSPs) is rising globally. Ultrasound criteria for the diagnosis of CSPs have been described by the International Society of Ultrasound in obstetrics and gynecology and appear to be well used in various centers around the world. There is no guidance on best practices for expectant management of CSP, and there is considerable variation in how this is offered globally. Many studies have reported significant maternal morbidity in cases of CSP with fetal cardiac activity managed expectantly, largely relating to hemorrhage and cesarean hysterectomy from placenta accreta spectrum. However, high live birth rates are also reported. Literature describing the diagnosis and expectant management of CSP in low-resource settings is lacking. Expectant management in selected cases where no fetal cardiac activity is present is a reasonable option and can be associated with good maternal outcomes. Standardization in reporting different types of CSPs and correlating these with pregnancy outcomes will be an important next step in developing guidance for expectant management of this high-risk pregnancy with a high burden of complications.

Cesarean Scar Pregnancy: Current Understanding and Treatment Including Role of Minimally Invasive Surgical Techniques.

The incidence of cesarean scar pregnancy (CSP) is increasing reflecting the global increase in cesarean section (CS) rate which has almost doubled since 2000. CSP differs from other types of ectopic pregnancy in its ability to progress while still carrying a significant risk of maternal morbidity. Little is known about precise etiology or natural history although current interest in the pathology of placenta accretes spectrum disorders might be enlightening. Early detection and treatment of CSP are challenging. Once diagnosed, the recommendation is to offer early termination of pregnancy because of the potential risks of continuing the pregnancy. However, as the likelihood of future pregnancy complications for any CSP varies depending on its individual characteristics, this might not always be necessary nor might it be the patient's preferred choice if she is asymptomatic, hemodynamically stable, and wants a baby. The literature supports an interventional rather than a medical approach but the safest and most efficient clinical approach to CSP in terms of treatment modality and service delivery has yet to be determined. This review aims to provide an overview of CSP etiology, natural history, and clinical implications. Treatment options and methods of CSP repair are discussed. We describe our experience in a large tertiary center in Singapore with around 16 cases/year where most treatment modalities are available as well as an "accreta service" for continuing pregnancies. We present a simple algorithm for approach to management including a method of triaging for those CSPs suitable for minimally invasive surgery.

Single-dose methotrexate-based protocol for the treatment of caesarean scar pregnancy and successive pregnancy outcomes

The incidence of caesarean scar pregnancy (CSP) increases in recent years. Yet, the best mode of treatment and its effects on successive pregnancies is not well established. The aim of this study was to investigate the success rate of single-dose methotrexate (MTX) in the management of CSP, and the outcomes of subsequent pregnancies in a retrospective cohort study. All women who were treated for CSPs between the years 2011 and 2019 were included. Treatment included systemic MTX and ultrasound-guided needle aspiration (UGNA) in cases with active foetal heartbeat. Overall, 34 women were diagnosed with CSP, of whom 31 were treated with systemic MTX. Twelve patients (38.7%) needed additional curettage or hysteroscopy. The only identified risk factor for failure of MTX-based treatment was time interval between the previous caesarean delivery and CSP (22 vs 34 months, p = 0.04). Twelve women had a subsequent pregnancy. Five pregnancies ended in term delivery, three in preterm delivery, three in abortion and one woman had a recurrent CSP. The study conclusion is that a single dose MTX with UGNA in cases of active heartbeat is an effective mode of treatment in cases of CSP with good sequential pregnancy outcomes. Longer time interval from the previous caesarean delivery was identified as a risk factor for failure of conservative management.

CESAREAN SCAR PREGNANCY - A RARE ENTITY BECOMING MORE COMMON - CASE SERIES.

Cesarean scar pregnancy is a rare and life threatening complication. As there is an increase in incidence of cesarean deliveries,there is also an increase in incidence of cesarean scar pregnancy. The complications of cesarean scar pregnancy are uterine rupture, massive haemorrhage, need for hysterectomy and risk of severe maternal morbidity and mortality. Here we present 7 cases of cesarean scar pregnancy illustrating the different diagnostic and therapeutic modalities..High suspicion of scar pregnancy in rst trimester bleeding with previous caesarean delivery,timely diagnosis and prompt management can prevent catastrophic complications

An updated guide to the diagnosis and management of cesarean scar pregnancies.

To review the current literature on the diagnosis and management of cesarean scar pregnancies RECENT FINDINGS: The incidence of cesarean scar pregnancies (CSPs) is increasing as a result of the increasing cesarean section rate, improved diagnostic capabilities, and a growing awareness. CSPs are associated with significant morbidity and early diagnosis is key. Diagnosis is best achieved with transvaginal ultrasound. Sonographic diagnostic criteria have been developed over decades and recently endorsed by the Society for Maternal-Fetal Medicine and other professional societies. The current categorization system differentiates CSPs that are endogenic or 'on the scar' from those that are exogenic or 'in the niche'. Following diagnosis, the challenge remains in determining the optimal management as multiple modalities can be considered. Studies have demonstrated the favorable outcomes with combined local and systemic methotrexate, surgical excision through multiple routes, and adjunctive therapies, such as uterine artery embolization or uterine balloons. The current evidence is insufficient to identify a single best treatment course and a combined approach to treatment is often required. Successful outcomes while minimizing complications can be achieved with a multidisciplinary, collaborative effort. Guidelines for cesarean scar pregnancies will continue to evolve as the published reports grow.

Clinical Efficacy of Combined Hysteroscopic and Laparoscopic Surgery and Reversible Ligation of the Uterine Artery for Excision and Repair of Uterine Scar in Patients with Type II and III Cesarean Scar Pregnancy.

BackgroundWith the changes in China’s family planning policy, the incidence of cesarean scar pregnancy (CSP) significantly increased in recent years. The present study aimed to investigate the clinical efficacy of combined hysteroscopic and laparoscopic surgery and reversible ligation of the uterine artery for cesarean scar excision and repair in patients with type II and III CSP.Material/MethodsThis was a retrospective study of 173 patients with type II and III CSP. They were assigned to the hysteroscopy and laparoscopy group (group A), hysteroscopy group (group B), and curettage group (group C) according to the surgery they underwent. The surgical indicators (intraoperative bleeding volume and hospital stay), postoperative recovery (time of serum β-hCG returning to the normal, postoperative residual lesion, the thickness of the uterine scar, and recovery time of menstruation), and the postoperative complications were compared among the 3 groups.ResultsIn patients with type II and III CSP, significant differences (P<0.05) were observed between group A vs. groups B and C in terms of the time of serum β-HCG returning to normal, postoperative residual lesions, the thickness of the uterine scar, and recovery time of menstruation, while there were no significant differences in intraoperative bleeding volume and postoperative hospital stay (P>0.05).ConclusionsFor patients with type II and III CSP, hysteroscopy and laparoscopy surgery and reversible ligation of the uterine artery achieved better clinical outcomes than hysteroscopy or curettage with respect to postoperative recovery. This could be suitable for patients with CSP and desire for fertility.

Clinical assessment of uterine artery embolization combined with curettage when treating patients with cesarean scar pregnancy: A retrospective study of 169 cases.

Recent years have witnessed an elevated incidence of cesarean scar pregnancy (CSP). However, the clinical complications and consequences of uterine artery embolization (UAE) and curettage treatment for CSP patients are not clear. We aimed to assess menstrual recovery and other clinically pertinent factors after UAE and curettage treatment in CSP patients. A total of 169 CSP patients who underwent UAE combined with curettage between August 2013 and August 2017 were enrolled in this study. The menstruation recovery was recorded, and the factors that potentially affected menstrual blood volume (MBV) were analyzed. Among the 169 CSP cases, 36 had asymptomatics (21.3%), 133 vaginal hemorrhage (78.7%) and 19 lower abdominal pain (11.2%). The success rate of treatment was 96.4% with six patients undergoing further treatment. The follow-up assessment was performed in 139 of 169 patients. About 83 of 139 (59.7%) patients had reduced MBV, and 2 patients (1.4%) had amenorrhea. There was a significant difference in numbers of abortions between the decreased and normal MBV group (P = 0.0276). Importantly, 16 of 42 cases who were planning on having babies became pregnant, with 8 from the decreased (8/27) and normal MBV (8/15) group each. UAE combined with curettage treatment in CSP patients demonstrates a favorable success rate, which can also reduce MBV and proceeding pregnancy rate.

Live Cesarean Scar Pregnancy: A Case Report

Introduction: The overall incidence of Cesarean scar pregnancy is increasing due to Cesarean rates. This life-threatening condition has been historically managed in various ways as no single modality is reliable enough. We report this case of live CSP managed initially with Fetocide followed by Methotrexate but requiring Surgical management later on. Presentation: A 32 years old para 5 with four previous Cesarean sections was diagnosed with live CSP. HCG level was 76,619. The initial management was fetocide with KCL followed by Methotrexate. The treatment was considered successful in view of appropriate reduction in serum HCG levels. The woman required surgical management 10 weeks after the initial management, but the blood loss was minimal. Discussion: A CSP may be asymptomatic or present with non-specific symptoms. The rate of initial misdiagnosis is as high as 76%. TVUSS enables correct CSP diagnosis and implementation of minimally invasive effective treatment. HCG levels can affect the overall outcome, but medical management can be considered even with high HCG levels. Conclusion: CSP is a life-threatening condition, therefore timely diagnosis and appropriate management is crucial. Medical management can be considered in most cases even with high HCG, but management has to be tailored according to the patient. Close follow up of patient after Medical treatment is important as they may require further intervention.

Caesarean scar ectopic pregnancy: Experience from an Australian tertiary centre.

Despite the rising incidence of caesarean scar pregnancy (CSP), as yet there are no consensus or evidence-based guidelines for management. To review diagnosis, treatment and management of all women with CSP over a 5year period at Mater Mothers' Hospital, Brisbane, Australia. Retrospective cohort study of CSP between 2013-2018. Data reviewed included demographics, presenting symptoms, gestational age, ultrasound findings, human chorionic gonadotrophin levels, treatment success, complications, and if available, subsequent pregnancy outcomes. Twenty-eight women were treated for CSP during the study period. Initial diagnosis was delayed in ten (36%). Overall success rates of initial treatment were 22/28 (79%). Of the six cases of failed treatment, five had been treated with systemic methotrexate alone. All women requiring further intervention had fetal pole present, and 50% had fetal cardiac activity. Failure rate of systemic methotrexate alone was 5/11 (45%). Eleven women deemed appropriate for conservative management did not require further treatment or experience complications. Nine women had data available for subsequent pregnancies, of whom two developed placenta accreta. This study provides data that may assist in guideline development and decision-making for management of CSP. Conservative management in carefully selected women appeared to be safe. Nearly half of women treated with systemic methotrexate alone required another treatment modality, suggesting a role for intralesional treatment, particularly in the presence of fetal pole ± fetal cardiac activity. More than one in five women with documented subsequent pregnancies were diagnosed with placenta accreta.

Caesarean Scar Pregnancy: A Case Series

Caesarean section rate is increasing day by day. Incidence of caesarean scar pregnancy (CSP) is also increasing. Prompt and multidisciplinary approach towards diagnosis of the condition is required to reduce associated morbidity. Major haemorrhage and hysterectomy are the main risks associated with CSP. Therefore, adequate counseling and availability of surgical expertise and blood transfusion should be part of a comprehensive management strategy. There are many single reports in literature but only few case series. In this paper, 10 cases of caesarean scar pregnancy treated in Obstetrics and Gynaecology department of CMH Dhaka, CMH Jashore and Hightech Multicare Hospital Private Limited over 10 years are analyzed. Three of 10 patients had mild pain in their lower abdomen and vaginal bleeding. Seven of them had profuse bleeding during D&amp;C for miscarriage as they were not diagnosed at the time of admission. All patients had 1 or 2 caesarean sections. Gestational age of the pregnancy was estimated from 8 to 12 weeks by the last menstrual period. 9 patients were treated surgically. Eight of them had local resection of ectopic pregnancy mass with conservation of the uterus. One patient was treated with D&amp;C followed by intrauterine balloon catheter insertion to control excessive bleeding. There was no total or subtotal hysterectomy. One patient was treated with Inj. Methotrexate. Common symptoms of caesarean scar pregnancy are pain in the lower abdomen and variable degree of vaginal bleeding. The treatment depends on severity of symptoms, gestational age and experience of the obstetrician dealing these cases.&#x0D; J Bangladesh Coll Phys Surg 2019; 37(4): 191-195

Early first-trimester transvaginal ultrasound is indicated in pregnancy after previous Cesarean delivery: should it be mandatory?

Early first-trimester transvaginal ultrasound is indicated in pregnancy after previous Cesarean delivery: should it be mandatory?

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.

Late diagnosis of a cesarean scar pregnancy: Rare form of an ectopic pregnancy case

Caesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy, which occurs with the placement of pregnancy to the defective myometrium area in the old cesarean scar. The incidence of CSP has been increasing in recent years because of the increasing cesarean rates and the more frequent use of transvaginal ultrasonography in early pregnancy all over the world. We present here our clinical approach in the cesarean scar pregnancy diagnosed at the 14th week of pregnancy at the age of 39, who had previously undergone 3 cesarean section operations.

Laparoscopic Management of Cesarean Scar Pregnancy

With the increase in cesarean deliveries worldwide, the reported incidence of cesarean scar pregnancies (CSPs) has increased [ 1 Timor-Tritsch IE Monteagudo A Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy. A review. Am J Obstet Gynecol. 2012; 207: 14-29 Abstract Full Text Full Text PDF PubMed Scopus (361) Google Scholar , 2 Gonzalez N Tulandi T Cesarean scar pregnancy: a systematic review. J Minim Invasive Gynecol. 2017; 24: 731-738 Abstract Full Text Full Text PDF PubMed Scopus (108) Google Scholar ]. Among conservative interventions, laparoscopic excision and repair may be an effective option, resulting in immediate recovery and remediation of the cesarean scar defect [ 3 Shao MJ Hu MX Hu M Temporary bilateral uterine artery occlusion combined with vasopressin in control of hemorrhage during laparoscopic management of cesarean scar pregnancies. J Minim Invasive Gynecol. 2013; 20: 205-208 Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar , 4 Wang YL Weng SS Huang WC Su TH Laparoscopic management of ectopic pregnancies in unusual locations. Taiwan J Obstet Gynecol. 2014; 53: 466-470 Crossref PubMed Scopus (14) Google Scholar , 5 Jiang S Zhao S Laparoscopic surgery for ectopic pregnancy within a cesarean scar. Clin Exp Obstet Gynecol. 2013; 40: 440-444 PubMed Google Scholar , 6 Wang HY Zhang J Li YN et al. Laparoscopic management of laparoscopy combined with transvaginal management of type II cesarean scar pregnancy. JSLS. 2013; 17: 263-272 Crossref PubMed Scopus (36) Google Scholar , 7 Fuchs N Manoucheri E Verbaan M Einarsson JI Laparoscopic management of extrauterine pregnancy in caesarean section scar: description of a surgical technique and review of the literature. BJOG. 2015; 122: 137-140 Crossref PubMed Scopus (25) Google Scholar , 8 Wang G Liu X Bi F et al. Evaluation of the efficacy of laparoscopic resection for the management of exogenous cesarean scar pregnancy. Fertil Steril. 2014; 101: 1501-1507 Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar ]. We retrospectively reviewed the clinical data of 8 women with CSPs treated in a tertiary medical center between October 2006 and October 2017. The mean gestational age at diagnosis was 6.8 weeks, and fetal cardiac activity was identified in 4 cases.

A Rare Case of an Arteriovenous Malformation Scar Pregnancy Treated With a Combined and Conservative Approach

A Rare Case of an Arteriovenous Malformation Scar Pregnancy Treated With a Combined and Conservative Approach

The Psychobiology and Genetics of Human Personality

To describe the incidence, management, and complications of cesarean scar pregnancy (CSP) and define risk factors for conversion from medical to surgical treatment of CSP.Retrospective clinical study (Canadian Task Force classification II-3).Tertiary medical center.All patients who were admitted and treated for CSP between 2008 and 2016.The cohort was divided according to management, and demographic, clinical, and sonographic data were collected. Rates of conversion were compared between groups, and risk factors necessitating conversion were sought.Forty-six cases of CSP were identified. The incidence of CSP has increased from 0.05% to 0.09% of all deliveries. A regression model for absolute numbers of CSP predicted an additional 0.47 CSP each year (p = .03). The most common treatment modalities were systemic treatment with methotrexate (28.2%) and ultrasound-guided intrasac injection of KCl with systemic treatment of methotrexate (58.7%). The mean sac diameter (MSD) of cases that were converted was 11.2 mm larger than in cases that were not converted (p < .001). No patients with an MSD <10 mm or a trophoblastic mass <20 mm3 were converted to surgical management. Maximal levels of beta human chorionic gonadotropin (β-hCG) were significantly associated with the risk of conversion. Only 6.3% of patients with a β-hCG level <10,000 IU at presentation were converted from medical to surgical management. There was no significant association between fetal cardiac activity and conversion from medical to surgical management.CSP has emerged as an important phenomenon in modern obstetrics and gynecology, and its frequency appears to be on the rise. The preferred method of treatment remains unclear; however, it is possible that a large MSD and trophoblastic mass at presentation should prompt surgical treatment.

Cesarean Scar Pregnancies: Incidence and Factors Associated with Conversion to Surgery from Medical Management

To describe the incidence, management, and complications of cesarean scar pregnancy (CSP) and define risk factors for conversion from medical to surgical treatment of CSP. Retrospective clinical study (Canadian Task Force classification II-3). Tertiary medical center. All patients who were admitted and treated for CSP between 2008 and 2016. The cohort was divided according to management, and demographic, clinical, and sonographic data were collected. Rates of conversion were compared between groups, and risk factors necessitating conversion were sought. Forty-six cases of CSP were identified. The incidence of CSP has increased from 0.05% to 0.09% of all deliveries. A regression model for absolute numbers of CSP predicted an additional 0.47 CSP each year (p = .03). The most common treatment modalities were systemic treatment with methotrexate (28.2%) and ultrasound-guided intrasac injection of KCl with systemic treatment of methotrexate (58.7%). The mean sac diameter (MSD) of cases that were converted was 11.2 mm larger than in cases that were not converted (p < .001). No patients with an MSD <10 mm or a trophoblastic mass <20 mm3 were converted to surgical management. Maximal levels of beta human chorionic gonadotropin (β-hCG) were significantly associated with the risk of conversion. Only 6.3% of patients with a β-hCG level <10,000 IU at presentation were converted from medical to surgical management. There was no significant association between fetal cardiac activity and conversion from medical to surgical management. CSP has emerged as an important phenomenon in modern obstetrics and gynecology, and its frequency appears to be on the rise. The preferred method of treatment remains unclear; however, it is possible that a large MSD and trophoblastic mass at presentation should prompt surgical treatment.

Caesarean scar pregnancy in the UK: a national cohort study.

To estimate the incidence of caesarean scar pregnancy (CSP) and to describe the management outcomes associated with this condition. A national cohort study using the UK Early Pregnancy Surveillance Service (UKEPSS). 86 participating Early Pregnancy Units. All women diagnosed in the participating units with CSP between November 2013 and January 2015. Cohort study of women identified through the UKEPSS monthly mailing system. Incidence, clinical outcomes and complications. 102 cases of CSP were reported, with an estimated incidence of 1.5 per 10 000 (95% CI 1.1-1.9) maternities. Full outcome data were available for 92 women. Management was expectant in 21/92 (23%), medical in 15/92 (16%) and surgical in 56/92 (61%). The success rates of expectant, medical and surgical management were 43% (9/21), 46% (7/15) and 96% (54/56), respectively. The complication rates were 15/21 (71%) with expectant, 9/15 (60%) with medical and 20/56 (36%) with surgical management. Discharge from care (median number of days) was 82 (range 37-174) with expectant, 21 (range 10-31) with medical and 11 (range 4-49) with surgical management. Surgical management appears to be associated with a high success rate, low complication rate and short post-treatment follow up. Surgery for CSP appears to be successful, with low complication rates and short post-treatment follow up.