101
|
Tan TT, Sun QL, Luo L, Chen Z, Xiong X, Xiang JH, Yan P, Gao CY, Chen ZQ. Validation of a 10-Point Scoring System for Treatment of Cesarean Scar Pregnancy. Ther Clin Risk Manag 2020; 16:429-436. [PMID: 32523347 PMCID: PMC7237119 DOI: 10.2147/tcrm.s243999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 04/13/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To validate a 10-point scoring system for the prediction of successful treatment modality in patients with cesarean scar pregnancy (CSP). Patients and Methods Data were collected from women seen between April 1, 2018, and June 30, 2019, at the Second Affiliated Hospital of Army Medical University of China who were diagnosed with CSP and underwent evacuation, followed by uterine artery embolization (UAE) and successive laparoscopic local resection as salvage treatment if necessary. A score was computed based on clinical and ultrasonographic parameters included in a previously developed scoring system. Treatment indicated by the scoring system was compared with actual treatment received. Receiver operating characteristic (ROC) curves were used to identify cut-off scores for salvage treatment. Results Of 183 women, 108 were successfully treated by evacuation, 57 required UAE, and 18 eventually underwent laparoscopic surgery. Among 97 women scoring 0–4, 89 (91.8%) were treated by evacuation only. Of 69 women scoring between 5 and 7, 44 (63.8%) needed UAE following evacuation. Of 17 women scoring 8–10, 10 women (58.8%) underwent laparoscopic surgery. A cut-off of 4.145 was obtained by ROC curve for prediction of any salvage treatment; this was comparable to the scale’s conventional cut-off of 4. The cut-off score for women requiring laparoscopic surgery was 6.580, which was lower than 8 obtained in the scale’s initial validation. Conclusion The overall performance of the 10-point scoring system was moderate for predicting successful treatment modalities of women with CSP, but the scale showed good predictive ability in recognizing women needing only evacuation before recovery. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/tsQjjM4rS6Y
Collapse
Affiliation(s)
- Ting-Ting Tan
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, People's Republic of China
| | - Qiu-Lei Sun
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, People's Republic of China
| | - Li Luo
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, People's Republic of China
| | - Zhu Chen
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, People's Republic of China
| | - Xi Xiong
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, People's Republic of China
| | - Jin-Hong Xiang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, People's Republic of China
| | - Ping Yan
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, People's Republic of China
| | - Chun-Yan Gao
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, People's Republic of China
| | - Zheng-Qiong Chen
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, People's Republic of China
| |
Collapse
|
102
|
Abstract
Cesarean scar pregnancy is a complication in which an early pregnancy implants in the scar from a prior cesarean delivery. This condition presents a substantial risk for severe maternal morbidity because of challenges in securing a prompt diagnosis, as well as uncertainty regarding optimal treatment once identified. Ultrasound is the primary imaging modality for cesarean scar pregnancy diagnosis, although a correct and timely determination can be difficult. Surgical, medical, and minimally invasive therapies have been described for cesarean scar pregnancy management, but the optimal treatment is not known. Women who decline treatment of a cesarean scar pregnancy should be counseled regarding the risk for severe morbidity. The following are Society for Maternal-Fetal Medicine recommendations: We recommend against expectant management of cesarean scar pregnancy (GRADE 1B); we suggest operative resection (with transvaginal or laparoscopic approaches when possible) or ultrasound-guided vacuum aspiration be considered for surgical management of cesarean scar pregnancy and that sharp curettage alone be avoided (GRADE 2C); we suggest intragestational methotrexate for medical treatment of cesarean scar pregnancy, with or without other treatment modalities (GRADE 2C); we recommend that systemic methotrexate alone not be used to treat cesarean scar pregnancy (GRADE 1C); in women who choose expectant management and continuation of a cesarean scar pregnancy, we recommend repeat cesarean delivery between 34 0/7 and 35 6/7 weeks of gestation (GRADE 1C); we recommend that women with a cesarean scar pregnancy be advised of the risks of another pregnancy and counseled regarding effective contraceptive methods, including long-acting reversible contraception and permanent contraception (GRADE 1C).
Collapse
|
103
|
Tsai NC, Cheng LY, Yang TH, Hsu TY, Kung FT. Serum β-human chorionic gonadotropin profile and its correlations with ultrasound parameters in low-lying-implantation ectopic pregnancy in the first trimester. J Obstet Gynaecol Res 2020; 46:844-850. [PMID: 32185850 DOI: 10.1111/jog.14248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/11/2020] [Accepted: 03/07/2020] [Indexed: 11/28/2022]
Abstract
AIM Cervical pregnancy (CP) and cesarean scar pregnancy (CSP), defined as low-lying-implantation ectopic pregnancy (LLIEP), are rare conditions of aberrant implantation around the lowest portion of the uterus. This study aimed to illustrate the serum β-human chorionic gonadotropin (β-hCG) profile of LLIEP and to explore its implications with the clinical characteristics. METHODS Women with LLIEP during the first trimester were retrospectively evaluated at a tertiary referral center from August 1999 to July 2016. Demographic and clinical data were recorded, including maternal age, gestational age (GA), serum β-hCG level, maximal diameter of the gestational mass/sac (MDM/MDS) by ultrasonography and CSP implantation types. The serum β-hCG level was measured on the day of ultrasound imaging. The significance of pretreatment the serum β-hCG level and its correlations with the clinical characteristics were analyzed. RESULTS A total of 88 LLIEP with 64 CSP and 24 CP was included. The mean GA at the time of diagnosis was 7 weeks (range, 5-12 weeks). The β-hCG concentrations rapidly increased from GA 5 to 9 weeks and fluctuated thereafter. The β-hCG levels correlated positively with GA and ultrasound MDM/MDS. In the CSP group, there was no difference in the β-hCG level between superficial and deep implantation types. β-hCG levels demonstrated no significant differences among simple and complicated LLIEP. CONCLUSION This study established the serum β-hCG profile in LLIEP in the first trimester. The exponential increase of β-hCG levels was similar to that of normal intrauterine pregnancies. The β-hCG levels were not associated with placentation complexity of CSP. Higher β-hCG levels did not implicate less success in conservative surgical management.
Collapse
Affiliation(s)
- Ni-Chin Tsai
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ling-Yun Cheng
- Department of Obstetrics and Gynecology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Tsai-Hwa Yang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Te-Yao Hsu
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Fu-Tsai Kung
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Obstetrics and Gynecology, Xiamen Chang Gung Hospital, Xiamen, China
| |
Collapse
|
104
|
Du Q, Liu G, Zhao W. A novel method for typing of cesarean scar pregnancy based on size of cesarean scar diverticulum and its significance in clinical decision-making. J Obstet Gynaecol Res 2020; 46:707-714. [PMID: 32153107 DOI: 10.1111/jog.14226] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 02/24/2020] [Indexed: 11/28/2022]
Abstract
AIM There is currently no universally accepted method for typing of cesarean scar pregnancy (CSP) to guide the choice of treatment approach. We introduce a new method for typing CSP and investigate its clinical significance. METHOD Clinical data of 198 patients with CSP were collected and analyzed. The patients were divided into three types according to the size of their cesarean scar diverticula (CSD), measured by magnetic resonance imaging: type I (size of CSD ≤40 mm), type II (40 mm < size of CSD ≤70 mm) and type III (size of CSD >70 mm). RESULTS With increase in the type level, the risk of adverse events increased significantly (χ2 = 36.345, P = 0.000). There was a significant difference in the choice of the treatment approaches in various types of the patients (χ2 = 27.106, P = 0.000). With increase in the type level, the invasiveness level of the treatment approach increased significantly (R = 0.405, P = 0.000). Further analysis found two other factors that influenced treatment choice. CONCLUSION Our study, for the first time, demonstrates the value of size of CSD in typing of CSP and, thereby supplements the CSP typing system with a novel quantitative indicator. This typing method is of significance for evaluation of risk of CSP and guiding the choice of treatment approach. This typing method, combined with the two features of cesarean scar thickness and lesions protruding outside the uterine contour, will improve the risk assessment of CSP and the rationale of treatment plan formulation for this condition.
Collapse
Affiliation(s)
- Qinghua Du
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Guipeng Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wancheng Zhao
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| |
Collapse
|
105
|
|
106
|
Traisrisilp K, Bootchaingam P, Sreshthaputra O, Tongsong T. Early prenatal detection of anterior uterine sacculation resulting from previous cesarean sections. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:111-114. [PMID: 31724183 DOI: 10.1002/jcu.22789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/07/2019] [Accepted: 10/30/2019] [Indexed: 06/10/2023]
Abstract
Anterior uterine sacculation was diagnosed at 15 weeks of gestation in a woman with two previous cesarean sections, based on hourglass appearance of two distinct uterine segments, namely the empty upper segment and the large thinned wall lower segment containing a fetus with posteriorly attached placenta. The pregnancy developed through the bulging weakened anterior wall instead of growing toward the upper segment. Urgent hysterectomy was performed. The operative and pathological findings confirmed the prenatal ultrasound findings. This is the first report of prenatal diagnosis of sacculation due to cesarean section, which prevented the catastrophic event of uterine rupture.
Collapse
Affiliation(s)
- Kuntharee Traisrisilp
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phenphan Bootchaingam
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Opas Sreshthaputra
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Theera Tongsong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
107
|
Hoffman T, Lin J. Cesarean Scar Ectopic Pregnancy: Diagnosis With Ultrasound. Clin Pract Cases Emerg Med 2020; 4:65-68. [PMID: 32064429 PMCID: PMC7012561 DOI: 10.5811/cpcem.2019.10.43988] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 10/14/2019] [Accepted: 10/17/2019] [Indexed: 12/18/2022] Open
Abstract
We present a rare case of cesarean scar ectopic pregnancy as diagnosed by transvaginal ultrasonography. Cases such as this are rare, but they are becoming more commonly detected with the growing frequency of cesarean sections, improving technology, and provider proficiency with point-of-care ultrasound. Quick identification of this dangerous diagnosis can be life saving for the patient, as the outcomes of ruptured cesarean ectopic pregnancy may include significant hemorrhage, uterine rupture, and possibly maternal death.
Collapse
Affiliation(s)
- Taryn Hoffman
- Maimonides Medical Center, Department of Emergency Medicine Brooklyn, New York
| | - Judy Lin
- Maimonides Medical Center, Department of Emergency Medicine Brooklyn, New York
| |
Collapse
|
108
|
Omand A, Aubrey C, Mills G, Tankel J. Myometrial Pseudoaneurysm and Myelosuppression Following Conservative Management of Cesarean Scar Ectopic Pregnancy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 42:798-801. [PMID: 31864915 DOI: 10.1016/j.jogc.2019.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/13/2019] [Accepted: 08/15/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Treatment of cesarean scar pregnancy is based on clinical context. This report describes two rare complications of conservative management: non-steroidal anti-inflammatory drug-induced methotrexate myelosuppression and myometrial pseudoaneurysm. CASE A 34-year-old woman was treated conservatively for a cesarean scar pregnancy with systemic methotrexate and intragestational potassium chloride, resulting in pancytopenia secondary to concurrent non-steroidal anti-inflammatory drug use. She presented again with a myometrial pseudoaneurysm, which was treated with bilateral uterine artery embolization and, ultimately, hysterectomy. The final pathology report confirmed a pseudoaneurysm, retained villi within the myometrium, and acute endometritis and myometritis. CONCLUSION Myelosuppression resulting from use of non-steroidal anti-inflammatory drugs affecting renal excretion of methotrexate can occur at low dosages. Additionally, there is a risk of pseudoaneurysms with vascular damage and trophoblastic tissue. Drug interactions and procedure-related risks must be considered when managing cesarean scar pregnancy conservatively.
Collapse
Affiliation(s)
- Alexandra Omand
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Christa Aubrey
- Department of Oncology, Faculty of Medicine, University of Calgary, Calgary, AB.
| | - Ginevra Mills
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry University of Alberta, Edmonton, AB
| | - Jonathan Tankel
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry University of Alberta, Edmonton, AB
| |
Collapse
|
109
|
Cesarean Scar Pregnancy with Iniencephaly and Progression to Placenta Accreta Due to Early Management Rejection. MATERNAL-FETAL MEDICINE 2019. [DOI: 10.1097/fm9.0000000000000025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
110
|
Tsakiridis I, Chatzikalogiannis I, Mamopoulos A, Dagklis T, Tsakmakidis G, Athanasiadis A, Kalogiannidis I. Cesarean scar pregnancy: A case report with surgical management after initially effective conservative treatment. Int J Surg Case Rep 2019; 65:238-241. [PMID: 31734475 PMCID: PMC6864124 DOI: 10.1016/j.ijscr.2019.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/24/2019] [Accepted: 11/01/2019] [Indexed: 11/08/2022] Open
Abstract
Cesarean scar pregnancies represent a severe obstetric entity, which is probably associated with the increasing rates of cesarean sections. There is no consensus on the preferred mode of treatment for cesarean scar pregnancies. Even after an initially effective conservative management, surgical management may be needed for the final treatment of cesarean scar pregnancies.
Introduction The incidence of cesarean scar pregnancies (CSPs) is increasing, possibly due to higher rates of cesarean sections. We report a case of a CSP with severe bleeding following initial conservative management, that was eventually treated surgically. Presentation of the case A 33-year old woman with history of one cesarean section presented with abdominal pain and amenorrhea and was diagnosed with CSP. Conservative management with methotrexate was chosen and the treatment was regarded as successful after the expected reduction in serum hCG levels. Four days after the hospital discharge, the patient was readmitted with hemodynamic instability and an emergency laparotomy was performed to remove the remaining trophoblastic tissue. Discussion A CSP may present as a threatened miscarriage, or remain asymptomatic through the first trimester. Medical treatment may be successful, however a close follow-up is needed even after a reduction in serum hCG levels. Conclusion We report a case of CSP that, following an initial apparently “successful” treatment with methotrexate, required surgical management due to heavy bleeding.
Collapse
Affiliation(s)
- Ioannis Tsakiridis
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece.
| | - Ioannis Chatzikalogiannis
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Apostolos Mamopoulos
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Themistoklis Dagklis
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Georgios Tsakmakidis
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Apostolos Athanasiadis
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Ioannis Kalogiannidis
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| |
Collapse
|
111
|
Qi F, Chai ZY, Liu MM, Zheng LZ, Zhu Y, Chen ZW, Lv WG. Type 2 Cesarean Scar Pregnancy Successfully Treated via Hysteroscopy-Assisted Laparoscopy. J Minim Invasive Gynecol 2019; 26:1273-1281. [DOI: 10.1016/j.jmig.2018.11.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 11/08/2018] [Accepted: 11/12/2018] [Indexed: 02/08/2023]
|
112
|
Conservative management of Caesarean scar pregnancies with systemic multidose methotrexate: predictors of treatment failure and reproductive outcomes. Reprod Biomed Online 2019; 39:827-834. [DOI: 10.1016/j.rbmo.2019.05.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/29/2019] [Accepted: 05/22/2019] [Indexed: 11/22/2022]
|
113
|
Wu Y, Zhou L, Chen L, Zhou Q, Zeng T. Efficacy of contrast-enhanced ultrasound for diagnosis of cesarean scar pregnancy type. Medicine (Baltimore) 2019; 98:e17741. [PMID: 31689823 PMCID: PMC6946507 DOI: 10.1097/md.0000000000017741] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES We compared the clinical efficacy of contrast-enhanced ultrasound (CEUS) to transvaginal ultrasound (TVS) for diagnosing cesarean scar pregnancy (CSP). METHODS A total of 485 cases of suspected CSP were recruited from January 2017 to March 2018. All received TVS and CEUS by two sonologists blinded to diagnosis by the other. Diagnostic features of CSP that significantly differed between modalities by univariate analysis (P < .05) were included in a logistic regression model. The sensitivity, specificity, positive likelihood ratio (+LR), negative likelihood ratio (-LR), and accuracy (ACC) of CSP diagnosis by TVS and CEUS were compared according to operational and pathological outcomes as the reference standard. RESULTS There were 220 CSP cases (including 85 cases of type I, 93 of type II, and 42 of type III). The sensitivities of CEUS for detection of types I - III CSP were 94.1%, 92.5%, and 97.6%, respectively, and corresponding sensitivities of TVS were 82.4%, 80.6%, and 95.2%. Compared to TVS, CEUS yielded significantly better overall sensitivity (97.27% vs 88.18%), specificity (96.60% vs 75.47%), +LR (28.60 vs 3.59), -LR (0.03 vs 0.16), and diagnostic ACC (96.9% vs 81.23%) (all P < .001). CONCLUSIONS CEUS is superior to TVS for detecting cesarean scar pregnancy and distinguishing among CSP types.
Collapse
|
114
|
Cesarean Scar Pregnancy, Incidence, and Recurrence: Five-Year Experience at a Single Tertiary Care Referral Center. Obstet Gynecol 2019; 132:1285-1295. [PMID: 30303911 DOI: 10.1097/aog.0000000000002940] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the treatment and subsequent pregnancy outcomes in patients with cesarean scar pregnancies at a single institution over 5 years. METHODS This is a case series of all cesarean scar pregnancies diagnosed from May 2013 to March 2018 at Yale-New Haven Hospital. Data were collected on each patient using electronic medical record review and included patient demographics; medical, surgical, and obstetric history; pregnancy characteristics; treatment modalities used; response to therapy; complications; and subsequent pregnancy outcomes. RESULTS Thirty cases of cesarean scar pregnancies were diagnosed in 26 patients, including one recurrence in one patient and three recurrences in another. Forty-six percent of cesarean scar pregnancies were in Hispanic women. The median number of prior cesarean deliveries was two. Mean gestational age at the time of diagnosis was 46 days (SD±10). Fetal cardiac activity was detected in 18 cases. Three patients initially were erroneously diagnosed with a viable intrauterine pregnancy and failed medical termination. Others opted for termination through systemic methotrexate alone (n=4), systemic and local methotrexate (n=12), systemic and local methotrexate with potassium chloride injected into the gestational sac (n=3), potassium chloride injection with laparotomy and wedge resection (n=1), methotrexate with bilateral uterine artery embolization (n=2), or intrauterine balloon (n=4). Five patients who underwent expectant management or methotrexate therapy had retained products of conception and required hysteroscopy and curettage. One patient opted for hysterectomy after failed curettage. After complete resolution of cesarean scar pregnancies, there were 10 subsequent spontaneous conceptions in eight patients, including four recurrent cesarean scar pregnancies, four term pregnancies, and one spontaneous abortion. One viable normally located pregnancy is ongoing. CONCLUSION There is a wide array of treatment modalities available for cesarean scar pregnancies. Women with a cesarean scar pregnancy are at risk for its recurrence in the future, although normal pregnancy after a cesarean scar pregnancy is also possible. Safe outcomes depend on timely diagnosis and multidisciplinary care by skilled clinicians.
Collapse
|
115
|
Timor-Tritsch IE, D'Antonio F, Calí G, Palacios-Jaraquemada J, Meyer J, Monteagudo A. Early first-trimester transvaginal ultrasound is indicated in pregnancy after previous Cesarean delivery: should it be mandatory? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:156-163. [PMID: 30677186 DOI: 10.1002/uog.20225] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 06/09/2023]
Affiliation(s)
- I E Timor-Tritsch
- NYU School of Medicine, Department of Obstetrics and Gynecology, New York, NY, USA
| | - F D'Antonio
- Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynaecology, University Hospital of Northern Norway, Tromsø, Norway
| | - G Calí
- Department of Obstetrics and Gynaecology, Arnas Civico Hospital, Palermo, Italy
| | - J Palacios-Jaraquemada
- Centre for Medical Education and Clinical Research (CEMIC), University Hospital, Buenos Aires, Argentina
| | - J Meyer
- NYU School of Medicine, Department of Obstetrics and Gynecology, New York, NY, USA
| | - A Monteagudo
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
116
|
Transvaginal hysterotomy: A novel approach for the treatment of cesarean scar pregnancy. Taiwan J Obstet Gynecol 2019; 58:460-464. [DOI: 10.1016/j.tjog.2019.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2019] [Indexed: 11/22/2022] Open
|
117
|
Laparoscopic Management of Cesarean Scar Pregnancy. J Minim Invasive Gynecol 2019; 26:798-799. [DOI: 10.1016/j.jmig.2018.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 12/07/2018] [Accepted: 12/08/2018] [Indexed: 11/19/2022]
|
118
|
Sun QL, Luo L, Gao CY, Yan P, Yang Y, Chen ZQ. Scoring system for the prediction of the successful treatment modality in women with cesarean scar pregnancy. Int J Gynaecol Obstet 2019; 146:289-295. [PMID: 31172522 DOI: 10.1002/ijgo.12881] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 11/25/2018] [Accepted: 06/06/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To establish a risk scoring system to predict the successful treatment of cesarean scar pregnancy. METHODS A prospective observational study was conducted between June 2016 and March 2018 in a tertiary care center. Patients received evacuation followed by uterine artery embolization and laparoscopic local resection/hysterectomy successively as salvage measures if necessary. Optimal scaling regression determined the extent of each potential prognostic factor predicted. RESULTS Out of 228 women, 144 cases required evacuation before recovery, 73 women required uterine artery embolization, and 11 women eventually required laparoscopic surgery. Six variables were included in the predictive model: number of cesarean deliveries; maximal diameter of gestational sac; remnant myometrial thickness; grading of Doppler signals; presence of fetal heartbeat; and location of gestational sac. A 10-point scoring system was established by weighting their prediction of the method of successful treatment. In the risk score rank of 1-4, only 4 (2.8%) out of 142 women needed uterine artery embolization as a salvage treatment, while in the risk score rank of 8-10, 41 (80.4%) cases needed uterine artery embolization; laparoscopic operations were performed by physicians for the other 10 (19.6%) cases. CONCLUSION The successful treatment of cesarean scar pregnancy was accurately predicted by a 10-point scoring system. CHINESE CLINICAL TRIALS REGISTRY ChiCTR-OOC-16008467.
Collapse
Affiliation(s)
- Qiu-Lei Sun
- Department of Obstetrics and Gynecology, the Second Clinical Medical College of Army Medical University, Chongqing, China
| | - Li Luo
- Department of Obstetrics and Gynecology, the Second Clinical Medical College of Army Medical University, Chongqing, China
| | - Chun-Yan Gao
- Department of Obstetrics and Gynecology, the Second Clinical Medical College of Army Medical University, Chongqing, China
| | - Ping Yan
- Department of Obstetrics and Gynecology, the Second Clinical Medical College of Army Medical University, Chongqing, China
| | - Ying Yang
- Department of Obstetrics and Gynecology, the Second Clinical Medical College of Army Medical University, Chongqing, China
| | - Zheng-Qiong Chen
- Department of Obstetrics and Gynecology, the Second Clinical Medical College of Army Medical University, Chongqing, China
| |
Collapse
|
119
|
Lu YM, Guo YR, Zhou MY, Wang Y. Indwelling Intrauterine Foley Balloon Catheter for Intraoperative and Postoperative Bleeding in Cesarean Scar Pregnancy. J Minim Invasive Gynecol 2019; 27:94-99. [PMID: 31212071 DOI: 10.1016/j.jmig.2019.02.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/01/2019] [Accepted: 02/20/2019] [Indexed: 12/31/2022]
Abstract
STUDY OBJECTIVE Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy, and a significant concern in the management of this condition is the control and prevention of bleeding. We aimed to determine the efficacy and value of an indwelling, intrauterine Foley balloon catheter in controlling and preventing intraoperative and postoperative bleeding in patients with CSP. DESIGN Retrospective case series. SETTING University-affiliated hospital. PATIENTS Between January 1, 2015 and May 31, 2017, 70 patients presented with CSP. INTERVENTIONS All patients underwent uterine curettage under hysteroscopic guidance and ultrasound monitoring. Patients were then assigned to 2 groups: the study group, with an indwelling Foley balloon catheter placed in the uterine cavity during surgery and retained for 24 to 48 hours, and the control group, without catheter placement. Data were collected to compare the 2 groups in terms of intraoperative and postoperative complications, surgical time, and status of menstruation resumption. MEASUREMENTS AND MAIN RESULTS The average daily volume of postoperative blood loss during the first 3 postoperative days in the study group was 23.1 mL compared with 31.5 mL observed in the control group (p = .041). Moreover, the study group had significantly shorter average duration of bleeding (p = .027) and fewer menstruation abnormalities than the control group. Uterine ultrasonography performed after resumption of menstruation showed that none of the enrolled patients had any intrauterine abnormalities. CONCLUSIONS The use of an indwelling, intrauterine Foley balloon catheter has positive results in the management of CSP.
Collapse
Affiliation(s)
- Yan-Ming Lu
- Department of Gynecology and Obstetrics, The Affiliated Shengjing Hospital, China Medical University, Shenyang, China (all authors)..
| | - Ya-Ru Guo
- Department of Gynecology and Obstetrics, The Affiliated Shengjing Hospital, China Medical University, Shenyang, China (all authors)
| | - Meng-Ya Zhou
- Department of Gynecology and Obstetrics, The Affiliated Shengjing Hospital, China Medical University, Shenyang, China (all authors)
| | - Yue Wang
- Department of Gynecology and Obstetrics, The Affiliated Shengjing Hospital, China Medical University, Shenyang, China (all authors)
| |
Collapse
|
120
|
Tanaka K, Coghill E, Ballard E, Sekar R, Amoako A, Khalil A, Baartz D. Management of caesarean scar pregnancy with high dose intravenous methotrexate infusion therapy: 10-year experience at a single tertiary centre. Eur J Obstet Gynecol Reprod Biol 2019; 237:28-32. [DOI: 10.1016/j.ejogrb.2019.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/01/2019] [Accepted: 04/08/2019] [Indexed: 10/27/2022]
|
121
|
Odgers HL, Taylor RAM, Balendran J, Benness C, Ludlow J. Rupture of a caesarean scar ectopic pregnancy: A case report. Case Rep Womens Health 2019; 22:e00120. [PMID: 31193006 PMCID: PMC6510699 DOI: 10.1016/j.crwh.2019.e00120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Caesarean scar pregnancy is an uncommon form of ectopic pregnancy characterized by implantation into the site of a caesarean scar. Common clinical features include vaginal bleeding and abdominal pain; however, a significant proportion of cases are asymptomatic. The primary diagnostic modality is transvaginal ultrasound. There is no current consensus on best-practice management. CASE PRESENTATION A 36-year-old woman, G7P2, presented to an early-pregnancy service with vaginal spotting and an ultrasound scan demonstrating a live caesarean scar ectopic pregnancy at 8 + 5 weeks' gestation. On examination she was hemodynamically stable with a soft abdomen. She was advised to have dilation and curettage (D&C) under ultrasound guidance; however, she was concerned that she might require more extensive surgery, such as a hysterectomy and so requested non-surgical management. On day 1 she underwent ultrasound-guided embryocide with lignocaine followed by inpatient multi-dose systemic methotrexate. Her beta-human gonadotrophic hormone level decreased. Repeat ultrasound on day 18 demonstrated a persistent caesarean scar ectopic pregnancy with increased vascularity, and so uterine artery embolization (UAE) was performed with a view to D&C the following day. This plan was altered to expectant management with ongoing follow-up by a different clinician who had had previous success with UAE alone. On day 35 the patient presented with life-threatening vaginal bleeding that required an emergency total abdominal hysterectomy. CONCLUSIONS Caesarean scar pregnancies are uncommon. Multiple treatment strategies have been employed, with variable degrees of success. Further research into risk stratification and management are needed to guide clinician and patient decision making.
Collapse
Affiliation(s)
| | | | | | - Christopher Benness
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
| | - Joanne Ludlow
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
122
|
Kitami K, Koike W, Nakamura H, Takeda A. Conservative endovascular and hysteroscopic management of a cesarean scar pregnancy in a woman with previous history of uterine artery embolization for intractable hemorrhage after cesarean section for placenta previa. Clin Case Rep 2019; 7:524-528. [PMID: 30899486 PMCID: PMC6406167 DOI: 10.1002/ccr3.2031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/08/2019] [Indexed: 11/10/2022] Open
Abstract
Transcatheter arterial chemoembolization (TACE), followed by hysteroscopic resection of the gestational products, could be a feasible option for the conservative management of cesarean scar pregnancy (CSP) in a woman with a previous history of uterine artery embolization (UAE) with coils for intractable hemorrhage after cesarean section.
Collapse
Affiliation(s)
- Kazuhisa Kitami
- Department of Obstetrics and GynecologyGifu Prefectural Tajimi HospitalTajimi, GifuJapan
| | - Wataru Koike
- Department of Diagnostic RadiologyGifu Prefectural Tajimi HospitalTajimi GifuJapan
| | - Hiromi Nakamura
- Department of Obstetrics and GynecologyGifu Prefectural Tajimi HospitalTajimi, GifuJapan
| | - Akihiro Takeda
- Department of Obstetrics and GynecologyGifu Prefectural Tajimi HospitalTajimi, GifuJapan
| |
Collapse
|
123
|
|
124
|
Tahaoglu AE, Dogan Y, Bakir MS, Baglı I, Peker N, Cavus Y, Togrul C, Tahaoglu Z. A single centre’s experience of caesarean scar pregnancy and proposal of a management algorithm. J OBSTET GYNAECOL 2018; 39:259-264. [DOI: 10.1080/01443615.2018.1499714] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Ali Emre Tahaoglu
- Department of Obstetrics and Gynecology, University of Health Sciences Gazi Yasargil Research and Training Hospital, Diyarbakir, Turkey
| | - Yasemin Dogan
- Department of Obstetrics and Gynecology, University of Health Sciences Gazi Yasargil Research and Training Hospital, Diyarbakir, Turkey
| | - Mehmet Sait Bakir
- Department of Obstetrics and Gynecology, University of Health Sciences Gazi Yasargil Research and Training Hospital, Diyarbakir, Turkey
| | - Ihsan Baglı
- Department of Obstetrics and Gynecology, University of Health Sciences Gazi Yasargil Research and Training Hospital, Diyarbakir, Turkey
| | - Nurullah Peker
- Department of Obstetrics and Gynecology, University of Health Sciences Gazi Yasargil Research and Training Hospital, Diyarbakir, Turkey
| | - Yunus Cavus
- Department of Obstetrics and Gynecology, University of Health Sciences Gazi Yasargil Research and Training Hospital, Diyarbakir, Turkey
| | - Cihan Togrul
- Department of Obstetrics and Gynecology, University of Health Sciences Gazi Yasargil Research and Training Hospital, Diyarbakir, Turkey
| | - Zelal Tahaoglu
- Department of Obstetrics and Gynecology, University of Health Sciences Gazi Yasargil Research and Training Hospital, Diyarbakir, Turkey
| |
Collapse
|
125
|
Abstract
Importance Cesarean scar ectopic pregnancy (CSEP) has a high rate of morbidity with nonspecific signs and symptoms making identification difficult. The criterion-standard treatment of CSEP has been subject to debate. Objective This review defines CSEP, discusses pathogenesis and diagnosis, and compares treatment options and outcomes. Evidence Acquisition A literature review was performed utilizing the term cesarean scar ectopic pregnancy and subsequently selecting only meta-analyses and systematic reviews. Only articles published in English were included. Relevant articles within the reviews were analyzed as necessary. Results Five basic pathways have been identified in treatment of CSEP: expectant management, medical therapy, surgical intervention, uterine artery embolization, or a combination approach. Expectant management has the highest probability of morbid outcomes, including hemorrhage, uterine rupture, and preterm delivery. Medical management often requires further treatment with additional medication or surgery. Different surgical methods have been explored including uterine artery embolization; dilation and curettage; surgical removal via vaginal, laparoscopic, or laparotomic approach; and hysterectomy. Each method has various levels of success and depends on surgeon skill and patient presentation. Conclusions Recent research supports any method that removes the pregnancy and scar to reduce morbidity and promote future fertility. Laparoscopic and transvaginal approaches are options for CSEP treatment, although continued research is required to identify the optimal approach. Relevance As cesarean delivery numbers rise, a subsequent increase in CSEPs can be anticipated. The ability to accurately diagnose and treat this morbid condition is vital to the practice of any specialist in general obstetrics and gynecology.
Collapse
|
126
|
Tahaoglu AE, Bakir MS, Dogan Y, Tahaoglu Z. Laparoscopic Resection of Cesarean Scar Pregnancy with Bilateral Uterine Artery Ligation. Gynecol Minim Invasive Ther 2018; 7:90-91. [PMID: 30254947 PMCID: PMC6113993 DOI: 10.4103/gmit.gmit_7_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ali Emre Tahaoglu
- Department of Gynecology and Obstetrics, Saglik Bilimleri University, Gazi Yasargil Research and Training Hospital, Diyarbakir, Turkey
| | - Mehmet Sait Bakir
- Department of Gynecology and Obstetrics, Saglik Bilimleri University, Gazi Yasargil Research and Training Hospital, Diyarbakir, Turkey
| | - Yasemin Dogan
- Department of Gynecology and Obstetrics, Saglik Bilimleri University, Gazi Yasargil Research and Training Hospital, Diyarbakir, Turkey
| | - Zelal Tahaoglu
- Department of Radiology, Saglik Bilimleri University, Gazi Yasargil Research and Training Hospital, Diyarbakir, Turkey
| |
Collapse
|
127
|
Cesarean Scar Pregnancy: A Case Series of Diagnosis, Treatment, and Results. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2018. [DOI: 10.1177/8756479318791155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim was to collect cases of cesarean scar pregnancy (CSP) and describe the evolution of diagnosis, treatment modalities, and outcome. A retrospective cohort study was conducted of patients who had been diagnosed with CSP. Treatment decision was made according to the type of CSP, levels of beta human chorionic gonadotropin (hCG), and estimated vascularity. Forty cases with CSP were recorded. Overall success of the primary treatment was recorded among 30 of 40 cases (75%) and significantly correlated with degree of vascularity, type of CSP, and beta hCG levels. The treatment methods included serial methotrexate in 20 cases; 15 of them (75%) were successful. In this specific group, we found type 2 scar and high vascularity to be significantly associated with treatment failure. In conclusion, cases with type 2 CSP, high vascularity, and high beta hCG levels should be considered high risk, and extra caution should be taken in choosing treatment modality and follow-up.
Collapse
|
128
|
Docheva N, Slutsky ED, Borella N, Mason R, Van Hook JW, Seo-Patel S. The Rising Triad of Cesarean Scar Pregnancy, Placenta Percreta, and Uterine Rupture: A Case Report and Comprehensive Review of the Literature. Case Rep Obstet Gynecol 2018; 2018:8797643. [PMID: 29984018 PMCID: PMC6011134 DOI: 10.1155/2018/8797643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 04/26/2018] [Indexed: 11/23/2022] Open
Abstract
As the rate of cesarean sections continues to rapidly rise, knowledge of diagnosis and management of cesarean scar pregnancies (CSPs) is becoming increasingly more relevant. CSPs rest on the continuum of placental abnormalities which include morbidly adherent placenta (accreta, increta, and percreta). A CSP poses a clinical challenge which may have significant fetal and maternal morbidity. At this point, no clear management guidelines and recommendations exist. Herein we describe the case of a second trimester CSP with rapid diagnosis and management in a tertiary care center. The case underscores the need for well-coordinated mobilization of resources and a multidisciplinary approach. A review of the literature is performed and deficits in universal management principles are underscored.
Collapse
Affiliation(s)
- Nikolina Docheva
- Department of Obstetrics and Gynecology, University of Toledo, Toledo, Ohio, USA
| | - Emily D. Slutsky
- Department of Obstetrics and Gynecology, University of Toledo, Toledo, Ohio, USA
| | - Nicolette Borella
- Mercyhurst University, Department of Biology, Eerie, Pennsylvania, USA
| | - Renee Mason
- Promedica Physicians Obstetrics-Gynecology, Maumee, Ohio, USA
| | - James W. Van Hook
- Department of Obstetrics and Gynecology, University of Toledo, Toledo, Ohio, USA
| | - Sonyoung Seo-Patel
- Department of Obstetrics and Gynecology, University of Toledo, Toledo, Ohio, USA
| |
Collapse
|
129
|
Tumenjargal A, Tokue H, Kishi H, Hirasawa H, Taketomi-Takahashi A, Tsushima Y. Uterine Artery Embolization Combined with Dilation and Curettage for the Treatment of Cesarean Scar Pregnancy: Efficacy and Future Fertility. Cardiovasc Intervent Radiol 2018; 41:1165-1173. [PMID: 29546456 DOI: 10.1007/s00270-018-1934-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/06/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the efficacy and safety of uterine artery embolization (UAE) followed by dilation and curettage (D&C) as a treatment for cesarean scar pregnancy (CSP) and to assess pregnancy outcomes after the treatment. MATERIALS AND METHODS We retrospectively analyzed 33 CSP patients treated with UAE followed by D&C. The serum level of beta human chorionic gonadotropin (β-hCG) normalization, hospitalization, menstruation, and successful pregnancy after treatment was assessed as clinical and pregnancy outcomes. RESULTS A total of 33 patients were initially treated without severe complications. However, four patients required additional systemic chemotherapy. β-hCG normalization took 35.5 ± 14.9 days (range 13-79), and the hospitalization was 6.5 ± 2.5 days (2-15). All patients resumed normal menstruation after 36 ± 19.2 days (12-86). Of 16 of 33 patients who desired pregnancy after the treatment, seven patients (43.8%) had uneventful parturition. CONCLUSIONS UAE combined with D&C was efficient and safe for CSP management. This minimally invasive procedure may be considered as one of the treatment options which enable preservation of fertility after treatment.
Collapse
Affiliation(s)
- Amartuvshin Tumenjargal
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
- Department of Obstetrics and Gynecology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Hiroyuki Tokue
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan.
| | - Hiroshi Kishi
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Gunma, 371-8511, Japan
| | - Hiromi Hirasawa
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Ayako Taketomi-Takahashi
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| |
Collapse
|
130
|
de Silva PS, Hansen HH, Wehberg S, Friedman S, Nørgård BM. Risk of Ectopic Pregnancy in Women With Inflammatory Bowel Disease: A 22-Year Nationwide Cohort Study. Clin Gastroenterol Hepatol 2018; 16:83-89.e1. [PMID: 28694133 DOI: 10.1016/j.cgh.2017.06.054] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/12/2017] [Accepted: 06/27/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Few data are available on adverse events of pregnancy in women with inflammatory bowel diseases (IBD), such as ectopic pregnancy. We assessed the risk of ectopic pregnancy in pregnancies of women in Denmark with IBD compared with those without IBD over a 22-year period. We also examined the disease-specific risks of ectopic pregnancies in pregnancies of women with ulcerative colitis (UC) or Crohn's disease (CD) who underwent IBD-related surgical procedures. METHODS We performed a retrospective study of all women of child-bearing age (ages, 15-50 y) registered in the Danish National Patient Registry with at least 1 pregnancy during the period from January 1994 through December 31, 2015. We collected data on all women with an ectopic pregnancy, hydatidiform mole, miscarriages (spontaneous and other abortions, including abnormal pregnancy products, missed abortion, and pregnancy without a fetus), induced abortions, and births in women with and without IBD. Our study population included 7548 pregnancies in women with UC, 6731 pregnancies in women with CD, and 1,832,732 pregnancies in women without IBD. We controlled for multiple covariates, including pelvic and abdominal surgery. RESULTS Women with CD had a greater risk of ectopic pregnancy, per pregnancy, than women without IBD (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.01-1.49), whereas women with UC did not (OR, 0.98; 95% CI, 0.80-1.20). In pregnancies of women with CD and UC who underwent IBD-related surgery before pregnancy, there was a nonsignificant increase in risk of ectopic pregnancy compared with pregnancies in women with IBD who did not have surgery (OR, 1.49; 95% CI, 0.91-2.44 for CD, and OR, 1.17; 95% CI, 0.54-2.52 for UC). CONCLUSIONS We found a statistically significant increased risk of ectopic pregnancy in pregnancies of women with CD compared with pregnancies of women without IBD. Surgery for IBD before pregnancy increased the risk of ectopic pregnancy, although this increase was not statistically significant.
Collapse
Affiliation(s)
- Punyanganie S de Silva
- Center for Crohn's and Colitis, Division of Gastroenterology, Hepatology & Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Helene H Hansen
- Center for Clinical Epidemiology, Odense University Hospital, Research Unit of Clinical Epidemiology, University of Southern Denmark, Odense, Denmark
| | - Sonja Wehberg
- Center for Clinical Epidemiology, Odense University Hospital, Research Unit of Clinical Epidemiology, University of Southern Denmark, Odense, Denmark
| | - Sonia Friedman
- Center for Crohn's and Colitis, Division of Gastroenterology, Hepatology & Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Clinical Epidemiology, Odense University Hospital, Research Unit of Clinical Epidemiology, University of Southern Denmark, Odense, Denmark
| | - Bente M Nørgård
- Center for Crohn's and Colitis, Division of Gastroenterology, Hepatology & Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Clinical Epidemiology, Odense University Hospital, Research Unit of Clinical Epidemiology, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
131
|
Gupta M, Kriplani A, Mahey R, Kriplani I. Successful management of caesarean scar live ectopic pregnancies with local KCL and systemic methotrexate. BMJ Case Rep 2017; 2017:bcr-2017-221844. [PMID: 29066656 DOI: 10.1136/bcr-2017-221844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Two cases of live caesarean scar ectopic pregnancies are presented. Beta human chorionic gonadotropin (b-hCG) values in both patients at presentation were 50 099 mIU and 297 969 mIU, respectively. Both were managed with intrasac potassium chloride injection to induce fetal demise and multiple dose methotrexate therapy. The time for b-hCG to become negative in both patients was 91 days and 119 days, respectively. Successful management of live caesarean scar pregnancies even with very high b-hCG is possible with minimally invasive approach.
Collapse
Affiliation(s)
- Monica Gupta
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Delhi, Delhi, India
| | - Alka Kriplani
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Delhi, Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Delhi, Delhi, India
| | - Isha Kriplani
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Delhi, Delhi, India
| |
Collapse
|
132
|
Kiyak H, Wetherilt LS, Seckin KD, Polat I, Kadirogullari P, Karacan T. Laparoscopic Excision of a Scar Pregnancy and Isthmocele Repair. J Minim Invasive Gynecol 2017; 25:582. [PMID: 29038043 DOI: 10.1016/j.jmig.2017.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 10/06/2017] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE Laparoscopic excision of a scar pregnancy and isthmocele repair with a barbed suture. DESIGN A step-by-step explanation of the laparoscopic excision technique of a scar pregnancy and isthmocele repair. SETTING Cesarean scar pregnancy occurs as a result of attachment of the products of conception to the uterine scar [1-3]. In the present case, a 34-year-old, gravida 4, para 1 patient with a history of 1 miscarriage and 1 ectopic pregnancy was diagnosed with type 2 cesarean scar pregnancy at 7 weeks of gestation. Dilation and curretage was performed at the 8th week of gestation to terminate the pregnancy. On ultrasonography performed 1 month later, placental material underlying the isthmocele was observed. Her beta human chorionic gonadotropin level was 13 836 mIU/mL. She was followed up for 1.5 months until the beta human chorionic gonadotropin levels were negative. However, the mass underneath the scar had grown larger, measuring up to 5 × 6 cm. Laparoscopy was performed because the patient reported vaginal spotting and pelvic pain. The incision was sutured with a synthetic absorbable unidirectional barbed suture (Stratafix Knotless Tissue Control Device; Ethicon Inc., Somerville, NJ). No residual scar defect was visible on follow-up ultrasonography 1 week and 1 month after surgery. CONCLUSION Barbed sutures ease the repair of uterine scar defects and can provide ideal reapproximation of thick myometrial tissue. Laparoscopic treatment of a scar pregnancy and isthmocele repair are effective and safe modes of treatment.
Collapse
Affiliation(s)
- Huseyin Kiyak
- Department of Obstetrics and Gynecology, University of Health Sciences, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Lale Susan Wetherilt
- Department of Obstetrics and Gynecology, University of Health Sciences, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Kerem Doga Seckin
- Department of Obstetrics and Gynecology, University of Health Sciences, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Ibrahim Polat
- Department of Obstetrics and Gynecology, University of Health Sciences, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Pınar Kadirogullari
- Department of Obstetrics and Gynecology, University of Health Sciences, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Tolga Karacan
- Department of Obstetrics and Gynecology, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey.
| |
Collapse
|
133
|
|
134
|
Tulandi T. Grossesse angulaire, grossesse interstitielle, grossesse sur cicatrice de césarienne et multiples doses de méthotrexate. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:613-614. [DOI: 10.1016/j.jogc.2017.03.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
135
|
Tulandi T. Angular Pregnancy, Interstitial Pregnancy, Caesarean Scar Pregnancy and Multidose Methotrexate. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:611-612. [PMID: 28410906 DOI: 10.1016/j.jogc.2017.03.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|