Previous Cesarean Section Scar Research Articles

Rotura uterina asociada a desprendimiento prematuro de placenta normalmente inserta en gestante de 25 semanas

We report a case of uterine rupture in a secundipara at 25 weeks’ gestation who was admitted to our center for premature rupture of membranes. Emergency cesarean section was performed due to suspicion of premature separation of a normally inserted placenta. Rupture of a previous cesarean section scar was observed.

Catch me if you scan: ultrasound diagnosis of ectopic pregnancy

In recent years, ultrasound has become an essential tool in the assessment of women with suspected early pregnancy complications1. A large number of studies has already been published, describing the value of ultrasound in the diagnosis of ectopic pregnancy2,3. So, why write yet another review on this topic? We run a busy Early Pregnancy Unit in the area with the highest prevalence of ectopic pregnancy in the UK, which also receives many referrals from other hospitals of women with an uncertain diagnosis of ectopic pregnancy. The most interesting fact that we have learned over the years is that the majority of women referred with suspected ectopic pregnancies in fact had intrauterine ones that were either missed on ultrasound examination or misinterpreted as ectopics. This may sound surprising to many, as ultrasound diagnosis of intrauterine pregnancy is considered to be relatively simple and accurate. In many cases, ultrasound examination failed to identify a small amount of retained products of conception, due in part to inconsistencies in the sonographic diagnosis of incomplete miscarriage; this is often based on the use of arbitrary cut-off levels for endometrial thickness4. In other cases, however, sonographers were unable to decide whether a visible gestational sac represented an intrauterine or an ectopic pregnancy. In some cases with uncertain diagnosis, women had already received medical treatment with methotrexate prior to referral, leading to the loss of wanted normal intrauterine pregnancies. Another common problem is difficulty in differentiating between the various types of ectopic pregnancy. An accurate differential diagnosis is important in ectopics, as the management often differs depending on the type and exact location of the pregnancy. The purpose of this review is to summarize the sonographic criteria for the diagnosis of both intrauterine and ectopic pregnancies and to describe the principles of differential diagnosis of various types of ectopic pregnancy. We will not cover management of pregnancies of unknown location, as this issue has been covered extensively in recent publications5.

Prise en charge obstétricale après grossesse ectopique intracicatricielle: à propos d'un cas et revue de la littérature

We report the case of a patient who came out pregnancy twelve months after medical and surgical treatment of an ectopic pregnancy in a previous caesarean section scar. The preconceptional management consisted in a saline infusion sonohysterography and a pelvic magnetic resonance imaging. Judging the risks of abnormal placental insertion to be higher in this case compared to a simple caesarean section, a careful ultrasonography with color doppler imaging was carried out. The myometrium fragility caused by the ectopic pregnancy in the caesarean section brought us to recommend a prophylactic caesarean section around 37. The high risks of hemorrhage required a medical center with embolization possibilities. A review of literature in order to define the medical care adapted in this case was come out.

Fetal survival following posterior uterine wall rupture during labour with intact previous caesarean section scar

Posterior wall rupture of the uterus in presence of previous caesarean scar is an extremely rare and unpredictable event. A 26-year old lady in her second pregnancy went into spontaneous labour at 41 weeks gestation. She had emergency caesarean section in her previous pregnancy. She made slow progress in labour to full dilatation without augmentation, but was noted to have fresh vaginal bleeding and breakthrough pain despite an epidural. Uterine scar rupture was suspected and an emergency lower segment caesarean section was carried out. Fresh intraperitoneal bleeding was noted but with an intact previous scar. The baby was delivered in good condition. A vertical posterior uterine wall rupture of the lower segment, 5 cm in length, was found to be bleeding profusely and was successfully repaired. Uterine rupture is a rare but serious complication. Usually the rupture occurs through the previous uterine scar. There are only four reported cases in the literature of posterior uterine rupture in labour through "healthy" uterine tissue in women with previous caesarean section. This is the first instance of fetal survival. The exact mechanism is unknown but likely to be a combination of factors including prostaglandin use, element of obstruction and strong inelastic scar. Strict vigilance is required during labour in women with previous scar. Early recognition of imminent scar rupture should speed delivery and improve the outcome for mother and baby.

Laparoscopic management of an ectopic pregnancy within a previous caesarean section scar

Ectopic pregnancy situated in a caesarean section scar is a rare but potentially life-threatening event. Because of its rarity there are no universal guidelines to manage this condition. We report a case of laparoscopic management of an ectopic pregnancy in a previous caesarean section scar. Laparoscopy enabled the successful treatment of an ectopic pregnancy, avoided unnecessary laparotomy and made it possible to preserve the patient’s reproductive capability. We discuss the management options and review the literature.

Frequency, predisposing factors and fetomaternal outcome in uterine rupture.

To determine the frequency and to analyze the predisposing factors, maternal and fetal outcome of uterine rupture. Cross-sectional study. The Department of Gynaecology and Obstetrics, Jinnah Postgraduate Medical Centre, Karachi from February 1997 to January 2000. All cases of ruptured uterus, who were either admitted with or who developed this complication in the hospital, were included in the study. Demographic data, details regarding the most probable predisposing factor, type of rupture, the management and maternal and fetal outcome were taken into consideration for analysis. During three years, total number of deliveries was 18668, and there were 103 cases of uterine rupture (0.55%). Out of these, only 13 (12.62%) patients were booked. Most of the patients presented between the ages of 26-30 years (42.71%). Majority of ruptures occurred in para 2-4 (44.66%). Fifty-five cases (53.39%) had a previous caesarean section scar. In 68 (66.01%) cases, the tear was located in lower uterine segment. In 93 (90.29%) cases, anterior uterine wall was involved. Rupture was complete in 79 (76.69%) cases. Repair of uterus was done in 79 (76.69%) cases. Hysterectomy was performed in 24 (23.30%) cases. There were 8 (7.76% or 77.66/1000) maternal deaths and 85 (81.73% or 825 / 1000) perinatal deaths. This study confirms high frequency of such serious preventable obstetrical problem which can lead to high fetomaternal mortality. Rupture of caesarean section scar was the most common cause of uterine rupture found in this series.

Preliminary report of treatment with oral contraceptive pills for intermenstrual vaginal bleeding secondary to a cesarean section scar

Uterine scar has been reported as a possible cause of intermenstrual bleeding in women with previous cesareans. We evaluated the effectiveness of combined hormonal therapy (estrogen and progesterone tablets containing 0.5 mg of norgestrel and 0.05 mg of ethynyl estradiol) in patients with recurring vaginal bleeding after cesarean section. Several cycles of the hormonal therapy eliminated the problem of abnormal vaginal bleeding, and the patients were satisfied with the treatment.

Recurrence of carcinoma cervix in the scar of previous cesarean section: a case report

Although rare, reports of carcinoma cervix recurring in abdominal incision, episiotomy scars, laparoscopic port sites, and drain sites are available. However, recurrence in the scar of a previous cesarean section (CS) is unreported. A 49-year-old female with a diagnosis of keratinizing squamous cell carcinoma (SCC) of cervix, stage IIB, was treated by radical radiotherapy. She had undergone CS, through midline abdominal incision, for three previous deliveries. Twenty months later, she presented with a nodule of size 2.5 x 2 cm(2) on the 26-year-old abdominal CS scar. Infiltration of the skin and extension into the deeper structures of the abdominal wall was present in an area of 5 x 4 cm(2). There was no evidence of disease on the cervix. A fine-needle aspiration cytologic examination from the nodule revealed keratinizing SCC. Ultrasonography and computerized tomography scan revealed a mass lesion along the abdominal CS scar with subcutaneous nodule and peritoneal extension. Multiple metastatic lesions were present in the liver. She was treated with chemotherapy and radiotherapy. The patient has lived for more than 12.5 months. The first report of recurrence of carcinoma cervix in a CS scar is presented. Literature on surgical scar recurrence in carcinoma cervix is reviewed.

Recurrence of carcinoma cervix in the scar of previous cesarean section: a case report

Recurrence of carcinoma cervix in the scar of previous cesarean section: a case report

Intramural pregnancy in a previous cesarean section scar: a case report on conservative surgery

Intramural pregnancy in a previous cesarean section scar: a case report on conservative surgery

Outcome of Subsequent Labour After Primary Caesarean Section For Arrest Disorders in Teenage Pregnancies

Context: Teenage mothers are at risk of numerous problems among which is cephalopeelvic disproportion or obstructed labour because of small and immature pelvis. This leads to a tendency to allowing trial of scar in subsequent pregnancies because the teenage pelvis might not have reached full capacity as at the time of the previous caesarean section. Despite the fact that some of the patients had a height of more than 152cm. Complications of scar dehiscence, haemorrhage, sepsis etc., and perinatal morbidity / therefore imperative to examine the outcome of labour in teenage mothers with one lower uterine segment caesarean section scar in which the section was done because of obstructed labour or CPD. Objective: To determine the outcome of trial of labour after one previous lower uterine segment transverse caesarean section. The main focus is possibility of vaginal delivery and associated morbidity mortality and mortality. Design: A longitudinal study (1993-1999). Participants And Methods: Teenage mothers with one previous lower transverse uterine segment caesarean section scar which was performed 2-3 Years earlier were allowed to labour. All these caesarean sections were primarily done because of cephalopelvic disproportion with or without obstructed labour.(excluded were those with more than 3 Years- as these were already over 19 Years). Setting: University of Maiduguri Teaching Hospital, Maiduguri, Nigeria. Main Outcome Measures: The possibility of vaginal delivery, the fetal outcome and associated morbidity and mortality. Results: 66 women were eligible for the study. 67% successfully achieved vaginal delivery. There was no maternal mortality even though there were 2 cases of ruptured uterus. Conclusion: Mothers aged 19 years and under with one previous transvere lower uterine segment caesarean section scar performed for cephalopelvic disproportion or obstructed labour should be allowed to labour with the aim of achieving vaginal delivery. This was found to be very possible and of benefit in this study. [Trop J Obstet Gynaecol, 2004;21:36-39]

Intramural pregnancy in a previous cesarean section scar: a case report on conservative surgery

Intramural pregnancy in a previous cesarean section scar: a case report on conservative surgery

Successful Conservative Treatment of a Cesarean Scar Pregnancy with Uterine Artery Embolization

Ectopic pregnancy developing in a previous Cesarean section scar is rare and is associated with catastrophic complications, such as uterine rupture and uncontrollable bleeding, which may lead to loss of the uterus. The operative treatments that have been reported for cesarean scar pregnancy are dilatation and curettage and excision of trophoblastic tissues using either laparotomy or laparoscopy. Recently, conservative treatment of scar pregnancy with locally and/or systemically administered methotrexate (MTX) has been reported. However, recent reports demonstrated that cases treated with MTX sometimes required laparotomy later because of excessive bleeding. In this series of cases we have demonstrated that viable cesarean scar pregnancies can be treated safely by selective transarterial embolization in combination with subsequent dilatation and curettage and local or systemic injections of MTX. In these three cases, uterine artery embolization proved to be a useful procedure for preventing uncontrollable bleeding and unnecessary uterine loss.

Three-Dimensional Power Doppler Ultrasound Diagnosis and Laparoscopic Management of a Pregancy in a Previous Cesarean Scar

An ectopic pregnancy developing in a previous Cesarean section scar is a rare event, and there is still a lack of information concerning the adequacy of management strategies. So far, no modality can guarantee the integrity of the uterus. We report the case of a 29-year-old woman with three Cesarean deliveries who was transferred to our hospital with a diagnosis of cervical pregnancy. Transvaginal three-dimensional power Doppler ultrasound revealed a well-encapsulated bulging mass displacing anteriorly over the lower anterior uterine wall sounding with an irregular course and branching vessels. The diagnosis of pregnancy in a previous Cesarean scar was made. Laparoscopic ligation of bilateral uterine arteries followed by excision of the ectopic pregnant mass was undertaken, and the patient's uterus was successfully preserved. Conservative management with the laparoscopic approach may be a safe and effective alternative to hysterectomy in patients with a pregnacy in a previous Cesarean scar.

Three-Dimensional Power Doppler Ultrasound Diagnosis and Laparoscopic Management of a Pregancy in a Previous Cesarean Scar

An ectopic pregnancy developing in a previous Cesarean section scar is a rare event, and there is still a lack of information concerning the adequacy of management strategies. So far, no modality can guarantee the integrity of the uterus. We report the case of a 29-year-old woman with three Cesarean deliveries who was transferred to our hospital with a diagnosis of cervical pregnancy. Transvaginal three-dimensional power Doppler ultrasound revealed a well-encapsulated bulging mass displacing anteriorly over the lower anterior uterine wall sounding with an irregular course and branching vessels. The diagnosis of pregnancy in a previous Cesarean scar was made. Laparoscopic ligation of bilateral uterine arteries followed by excision of the ectopic pregnant mass was undertaken, and the patient's uterus was successfully preserved. Conservative management with the laparoscopic approach may be a safe and effective alternative to hysterectomy in patients with a pregnacy in a previous Cesarean scar.

Obstetric Uterine Rupture: A 20-Year Clinical Analysis

To analyze the obstetric and gynecologic history of women with uterine rupture during pregnancy, and examine maternal and perinatal morbidity and mortality outcomes after uterine rupture. A retrospective review of patients with rupture of the gravid uterus at Mackay Memorial Hospital, for the period between January 1984 and September 2003, was undertaken. The records of these patients were studied with regard to previous cesarean section, the use of uterine stimulants, the use of instruments in delivery, clinical features, treatment modality, and maternal and fetal morbidity and mortality. A total of 21 cases of rupture of the gravid uterus were found. The prevalence of uterine rupture was 1 in 6,056 deliveries. The most common risk factor was previous cesarean section scar (48%). Fetal distress (43%) and postpartum hemorrhage (24%) were the two most common manifestations of ruptured uterus. Fourteen cases were term pregnancies. However, seven cases presented before term, including one in the first trimester, two in the second trimester, and four in the early third trimester. There was only one maternal death (5%), but five cases (24%) presented with intrauterine fetal demise. Physicians should be alert to the possibility of uterine rupture at all stages of pregnancy. The ability to recognize the various signs of a possible rupture event, such as fetal distress, maternal pain, or hypotension, and then to address the situation immediately, is critical to a good outcome.

Ectopic Pregnancy Within a Cesarean Section Scar: Report of Two Cases

Objective: Ectopic pregnancy embedded in a previous cesarean section scar is rare. We report two cases of cesarean section scar pregnancy managed with conservative treatment. Case Reports: The first patient was a 39-year-old woman who presented with vaginal spotting and delayed menstruatuion. She had undergone two previous cesarean sections sections and was found to be at 5 weeks’ gestation. The second patient was a 38-year-old woman with one previous cesarean section. She presented with vaginal bleeding and abdominal fullness and was found to be at 7 weeks’ gestation. In both cases, cesarean section scar pregnancies were diagnosed by transvaginal sonographic guidance, followed by multiple doses of intramuscular MTX. Serum β-human chorionic gonadotropin levels declined gradually and reabsorption of the gestational sacs was confirmed by sonography. Conclusions: Early detection of cesarean section scar pregnancy allowed the choice of several conservative treatment options. Intragestational sac injection of MTX systemic was effective in terminating the ectopic pregnancy, even after a fetal heartbeat was detected.

Embarazo ectópico sobre cicatriz de cesárea anterior

Ectopic pregnancy in a previous cesarean section scar is the rarest of ectopic pregnancy locations and is possibly one of the most dangerous because of the risk of uterine rupture and hemorrhage. Few reports on this type of ectopic pregnancy have been published and differential diagnosis may be difficult. Because the diagnostic criteria and prognosis are uncertain, consensus on the preferred treatment is lacking.

Gestación ectópica sobre cicatriz de cesárea anterior: caso clínico y revisión de la literatura

Pregnancy in a previous cesarean scar is the rarest of all ectopic pregnancies with the potential for severe complications such as uterine rupture and hemorrhage, requiring an emergency hysterectomy. However, the advent of transvaginal sonography has enabled earlier diagnosis and the application of more conservative therapeutic approaches. Several modalities have been proposed, revealing that no single option is suitable for all casesWe describe the case of an ectopic pregnancy that developed in a previous cesarean section scar and was diagnosed by ultrasound at 6 weeks of amenorrhea. It was successfully treated by combined administration of methotrexate, bothsystemic and intrasac. Human chorionic gonadotropin returned to non-pregnancy levels at 6 weeks. The various therapeutic strategies and their advantages and disadvantages are discussed

Ectopic Pregnancy In A Previous Cesarean Section Scar: A Case Report

Objective: The aim of this study is to evaluate an ectopic pregnancy developing in a previous cesarean section scar. Case: A 38 year-old woman was referred at eight weeks, due to ectopic pregnancy. Three years before she had undergone cesarean section. She needed a reoperation because of dehiscence However, a incisional hernia reoccurred. The incisional hernia was repaired with prolene mash six months ago. The ectopic pregnancy was diagnosed by transvaginal ultrasound at eight weeks of viable fetus with intact and irregular gestational sac in the previous cesarean scar. A laparotomy was performed. Conclusion: The ectopic pregnancy within the scar of a previous cesarean delivery is the best diagnosed by transvaginal ultrasound. However, a delay in either diagnosis or treatment can lead to uterine rupture, hysterectomy, and significant maternal morbidity. As soon as the diagnosis is confirmed, primer surgical treatment by laparotomy should be recommended