Cesarean Scar Ectopic Pregnancy: The Lurking Danger in Post Cesarean Failed Medical Abortion
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Abstract
Cesarean scar pregnancy (CSP) is a potentially life threatening ectopic pregnancy where a missed diagnosis is commoner than an accurate diagnosis. Incidence of Ectopic pregnancy is 1 – 2 % and cesarean scar ectopic occurs in about (0.05%) 1 in 2000 of all pregnancies. With increasing cesarean section rates worldwide, CSP is bound to increase with its dreaded complications like uterine rupture and catastrophic hemorrhage. Three patients misdiagnosed as incomplete miscarriages in post cesarean pregnancies in other centers were found to be CSP in Gynaecology department of a tertiary level hospital. All three patients were managed successfully, two surgically and one medically.
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4. Marchiolé P, Gorlero F, de Caro G, Podestà M, Valenzano M. Intramural Pregnancy embedded in a previous Cesarean section scar treated conservatively. Ultrasound Obstet Gynecol 2004; 23: 307-9.
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7. D'Antonio F, Timor-Tritsch IE, Palacios-Jaraquemada J, Monteagudo A, Buca D, Forlani F, ET al.First-trimester detection of abnormally invasive placenta in high-risk women: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2018; 51: 176-83.
8. 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.
9. Huang Q, Zhang M, Zhai RY. The use of contrast-enhanced magnetic resonance Imaging to diagnose cesarean scar pregnancies. Int J Gynaecol Obstet. 2014; 127: 144-6.
10. Smith A, Ash A, Maxwell D. Sonographic diagnosis of cesarean scar pregnancy at 16 weeks. J Clin Ultrasound 2007; 35: 212-5.
11. Wang YL, Su TH, Chen HS. Operative laparoscopy for unruptured ectopic pregnancy in a caesarean scar. BJOG 2006; 113: 1035-8.
12. Wang HY, Zhang J, Li YN, Wei W, Zhang DW, Lu YQ, et al. Laparoscopic management or laparoscopy combined with transvaginal management of type IICesarean scar pregnancy. JSLS 2013; 17: 263-72.
13. Deans R, Abbott J. Hysteroscopic management of cesarean scar ectopic pregnancy. Fertil Steril 2010; 93: 1735-40.
14. Jurkovic D, Knez J, Appiah A, Farahani L, Mavrelos D, Ross JA. Surgical treatment of Cesarean scar ectopic pregnancy: efficacy and safety of ultrasound-guided suction curettage. Ultrasound Obstet Gynecol 2016; 47: 511-7.
15. Liu S, Sun J, Cai B, Xi X, Yang L, Sun Y. Management of Cesarean Scar pregnancy Using Ultrasound-Guided Dilation and Curettage. J Minim Invasive Gynecol 2016; 23: 707-11.
16. Deb S, Clewes J, Hewer C, Raine-Fenning N. The management of Cesarean scar ectopic pregnancy following treatment with methotrexate--a clinical challenge.Ultrasound Obstet Gynecol 2007; 30: 889-92.
17. Timor-Tritsch IE, Monteagudo A, Santos R, Tsymbal T, Pineda G, Arslan AA. The diagnosis, treatment, and follow-up of cesarean scar pregnancy. Am J Obstet Gynecol. 2012; 207: 44.e1-13.
18. Jayaram, PM, Okunoye, GO, Konje, J. Caesarean scar ectopic pregnancy: diagnostic challenges and management options. The Obstetrician & Gynaecologist 2017; 19: 13–20.
2. Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol 2006; 107: 1373-81.
3. Ash A, Smith A, Maxwell D. Caesarean scar pregnancy. BJOG 2007 114: 253-63.
4. Marchiolé P, Gorlero F, de Caro G, Podestà M, Valenzano M. Intramural Pregnancy embedded in a previous Cesarean section scar treated conservatively. Ultrasound Obstet Gynecol 2004; 23: 307-9.
5. Larsen JV, Solomon MH. Pregnancy in a uterine scar sacculus--an unusual cause of postabortal haemorrhage.
A case report. S Afr Med J 1978; 53:142-3.
6. Fylstra DL. Ectopic pregnancy within a cesarean scar: a review. Obstet Gynecol Surv 2002; 57: 537-43.
7. D'Antonio F, Timor-Tritsch IE, Palacios-Jaraquemada J, Monteagudo A, Buca D, Forlani F, ET al.First-trimester detection of abnormally invasive placenta in high-risk women: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2018; 51: 176-83.
8. 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.
9. Huang Q, Zhang M, Zhai RY. The use of contrast-enhanced magnetic resonance Imaging to diagnose cesarean scar pregnancies. Int J Gynaecol Obstet. 2014; 127: 144-6.
10. Smith A, Ash A, Maxwell D. Sonographic diagnosis of cesarean scar pregnancy at 16 weeks. J Clin Ultrasound 2007; 35: 212-5.
11. Wang YL, Su TH, Chen HS. Operative laparoscopy for unruptured ectopic pregnancy in a caesarean scar. BJOG 2006; 113: 1035-8.
12. Wang HY, Zhang J, Li YN, Wei W, Zhang DW, Lu YQ, et al. Laparoscopic management or laparoscopy combined with transvaginal management of type IICesarean scar pregnancy. JSLS 2013; 17: 263-72.
13. Deans R, Abbott J. Hysteroscopic management of cesarean scar ectopic pregnancy. Fertil Steril 2010; 93: 1735-40.
14. Jurkovic D, Knez J, Appiah A, Farahani L, Mavrelos D, Ross JA. Surgical treatment of Cesarean scar ectopic pregnancy: efficacy and safety of ultrasound-guided suction curettage. Ultrasound Obstet Gynecol 2016; 47: 511-7.
15. Liu S, Sun J, Cai B, Xi X, Yang L, Sun Y. Management of Cesarean Scar pregnancy Using Ultrasound-Guided Dilation and Curettage. J Minim Invasive Gynecol 2016; 23: 707-11.
16. Deb S, Clewes J, Hewer C, Raine-Fenning N. The management of Cesarean scar ectopic pregnancy following treatment with methotrexate--a clinical challenge.Ultrasound Obstet Gynecol 2007; 30: 889-92.
17. Timor-Tritsch IE, Monteagudo A, Santos R, Tsymbal T, Pineda G, Arslan AA. The diagnosis, treatment, and follow-up of cesarean scar pregnancy. Am J Obstet Gynecol. 2012; 207: 44.e1-13.
18. Jayaram, PM, Okunoye, GO, Konje, J. Caesarean scar ectopic pregnancy: diagnostic challenges and management options. The Obstetrician & Gynaecologist 2017; 19: 13–20.
| Files | ||
| Issue | Vol 13, No 4 (December 2019) | |
| Section | Case Reports | |
| DOI | https://doi.org/10.18502/jfrh.v13i4.2651 | |
| Keywords | ||
| Ectopic Pregnancy Scar Ectopic Laparoscopy Methotrexate | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Anant M, Paswan A, Jyoti C. Cesarean Scar Ectopic Pregnancy: The Lurking Danger in Post Cesarean Failed Medical Abortion. J Family Reprod Health. 2019;13(4):223-227.
