Scar Ectopic Pregnancy: A New Threat to Pregnant Women
Abstract
Caesarean scar pregnancy (CSP) is defined as implantation into the myometrial defect occurring at the site of the previous uterine incision. Because of the rising rates of caesarean sections globally as well as the improved diagnostic abilities of transvaginal (TVS) ultrasound, incidence of CSP has continued to rise. Diagnosis is based on combination of patient’s history, clinical manifestations, and imaging. Given the rarity of this condition, there is no consensus in the management of CSP. Medical management is associated with a longer follow up time as compared with surgical management. Patients with previous CSP are at high risk of recurrence of CSP, future uterine rupture and abnormalities of placenta implantation. The main aim of treatment is to prevent massive blood loss and conserve the uterus to maintain future fertility, women’s health, and quality of life. Each case should be carefully assessed and treatment must be individualized.
References
2. Ash A, Smith A, Maxwell D. Caesarean scar pregnancy,” BJOG 2007; vol.114, no.3: 253–263, 2007.
3. KaelinAgten A, Cali G, Timor-Tritsch I. The clinical outcome of caesarean scar pregnancies implanted “on the scar” versus “in the niche”. American Journal of Obstetrics & Gynaecology 2017; vol.216, no. 5:1–6.
4. Rotas MA, Haberman S, Levgur M. Caesarean scar ectopic pregnancies: aetiology, diagnosis and management. ObstetGynecol 2006; 107:1373–81.
5. Silver RM, Landon MB, Spong CY. Maternal morbidity associated with multiple repeat caesarean deliveries. ObstetGynecol 2006; 107: 1226-1232.
6. Jayaram P, Okunoye G, Konje J. Caesarean scar ectopic pregnancy: diagnostic challenges and management options. RCOG The Obstetrician & Gynaecologist 2017; 19:13-20.
7. Bodur S, Ozdamar O, G¨un I. The efficacy of systemic methotrexate treatment in caesarean scar ectopic pregnancy: A quantitative review of English literature. Journal
of Obstetrics & Gynaecology 2015; vol.35, no.3: 290–296.
8. Seow KM, Huang LW, Hwang JL. Caesarean scar pregnancy: issues in management. Ultrasound ObstetGynecol 2004; Mar; 23(3): 247-53.
9. Hartungand J, Meckies J. Management of a case of uterine scar pregnancy by transabdominal potassium chloride injection. Ultrasound in Obstetrics & Gynaecology 2003; vol. 21, no.1: 94-95.
10. Timor-Tritsch IE, Monteagudo A, Arslan AA. The diagnosis, treatment and follow-up of caesarean scar pregnancy. Am J Obstet Gynecol. 2012; 207: 44. e1-44. e13.
11. Hong Y, Guo Q, Lu D, Hu M. Outcome of high-intensity focused ultrasound and uterine artery embolization in the treatment and management of caesarean scar pregnancy: A retrospective study. Medicine (Baltimore). 2017 Jul; 96 (30): e7687.
12. Jurkovic D, Ben-Nagi J, Ofilli-Yebovi D, Sawyer E, Helmy S, Yazbek J. Efficacy of Shirodkar cervical suture in securing haemostasis following surgical evacuation of Caesarean scar ectopic pregnancy. Ultrasound ObstetGynecol 2007; 30:95–100.
13. Ben Nagi J, Helmy S, Jurkovic D. Reproductive outcomes of women with a previous history of Caesarean scar ectopic pregnancies. Human Reproduction 2007. Vol.22, No.7: 2012–2015.
14. Gao L, Huang Z Wang X. Reproductive outcomes following caesarean scar pregnancy: A case series and review of literature. European Journal of Obstetrics & Gynaecology and Reproductive Biology 2016; vol.200: 102–107.
