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Timor-Tritsch IE, Monteagudo A, Goldstein SR. Early first-trimester transvaginal ultrasound screening for cesarean scar pregnancy in patients with previous cesarean delivery: analysis of the evidence. Am J Obstet Gynecol 2024:S0002-9378(24)00732-4. [PMID: 38955324 DOI: 10.1016/j.ajog.2024.06.041] [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: 08/20/2023] [Revised: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 07/04/2024]
Abstract
Obstetric hemorrhage is a leading cause of maternal morbidity and mortality. An important etiology of obstetric hemorrhage is placenta accreta spectrum. In the last 2 decades, there has been increased clinical experience of the devastating effect of undiagnosed, as well as late diagnosed, cases of cesarean scar pregnancy. There is a growing body of evidence suggesting that cesarean scar pregnancy is an early precursor of second- and third-trimester placenta accreta spectrum. As such, cesarean scar pregnancy should be diagnosed in the early first trimester. This early diagnosis could be achieved by introducing regimented sonographic screening in pregnancies of patients with previous cesarean delivery. This opinion article evaluates the scientific and clinical basis of whether cesarean scar pregnancy, with special focus on its early first-trimester discovery, complies with the accepted requirements of a screening test. Each of the 10 classical screening criteria of Wilson and Jungner were systematically applied to evaluate if the criteria were met by cesarean scar pregnancy, to analyze if it is possible and realistic to carry out screening in a population-wide fashion.
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Affiliation(s)
- Ilan E Timor-Tritsch
- Department of Obstetrics and Gynecology, Hackensack Meridian School of Medicine, Nutley, NJ.
| | - Ana Monteagudo
- Department of Obstetrics and Gynecology, Icahn School of Medicine, New York, NY
| | - Steven R Goldstein
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY
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Al Farsi AR. Cesarean Scar Pregnancy: Time to Initiate Universal Screening. Oman Med J 2023; 38:e564. [PMID: 38283208 PMCID: PMC10822124 DOI: 10.5001/omj.2023.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024] Open
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Pekar-Zlotin M, Zur-Naaman H, Maymon R, Tsviban A, Melcer Y. Outcomes of Cesarean Scar Pregnancies in Early Gestation According to the New Delphi Consensus Criteria. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2039-2044. [PMID: 36929872 DOI: 10.1002/jum.16222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/10/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Clinical evaluation of the new Delphi consensus definition of cesarean scar pregnancy (CSP) in early gestation. METHODS A retrospective cohort of 36 women diagnosed with CSP and treated with combined local and systemic methotrexate (MTX) between 2008 and 2021. The CSPs were classified according to the new Delphi consensus criteria into three subgroups based on the depth of the gestational sac herniation in the sagittal plane. Subgroup A included 8 (22.2%) cases in which the largest part of the gestational sac protruded toward the uterine cavity. Subgroup B included 22 (61.1%) cases in which the largest part of the gestational sac was embedded in the myometrium, and subgroup C included 6 (16.7%) cases in which the gestational was partially located outside the outer contour of the cervix or uterus. RESULTS The β-HCG level upon admission was significantly lower in subgroup A than in subgroups B or C (11,075 ± 7109, 18,787 ± 16,585, and 58,273 ± 55,267 mIU/mL, respectively, P = .01). All subgroup C patients had repeated courses of MTX and surgical interventions (laparotomy, uterine artery embolization, and operative hysteroscopy) at double the rate of subgroups A or B (100, 50, and 40.9%, respectively, P = .036). The duration of hospitalization was significantly shorter in subgroup A than in subgroups B or C (1.9 ± 1.5, 2.1 ± 1.1, and 5.4 ± 4.9 days, P = .01). CONCLUSIONS The outcome according to Delphi consensus criteria for defining CSP in early gestation has implications for clinical decision-making, patient care, and the follow-up of CSP.
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Affiliation(s)
- Marina Pekar-Zlotin
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (Formerly Assaf Harofeh Medical Center), Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hili Zur-Naaman
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (Formerly Assaf Harofeh Medical Center), Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Maymon
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (Formerly Assaf Harofeh Medical Center), Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anna Tsviban
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (Formerly Assaf Harofeh Medical Center), Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaakov Melcer
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (Formerly Assaf Harofeh Medical Center), Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Rouvalis A, Vlastarakos P, Daskalakis G, Pouliakis A, Stavrou S, Tsiriva M, Giourga M, Gerede A, Pappa K, Gregoriadis T, Vlachos DE, Rodolakis A, Domali E. Caesarean Scar Pregnancy: Single Dose of Intrasac Ultrasound-Guided Methotrexate Injection Seems to be a Safe Option for Treatment. Ultrasound Int Open 2023; 9:E18-E25. [PMID: 37727679 PMCID: PMC10506866 DOI: 10.1055/a-2137-8318] [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: 10/04/2022] [Accepted: 03/15/2023] [Indexed: 09/21/2023] Open
Abstract
Objective The purpose of the study was to assess the efficacy of local ultrasound-guided methotrexate injection in patients with caesarean section scar pregnancy, to chart the course of beta-human chorionic gonadotropin levels (HCG) after treatment, and to see if HCG levels are correlated with clinical presentation. Methods Between May 2018 and January 2021, data were collected retrospectively from the Early Pregnancy Unit of a tertiary hospital. Results Our clinic assessed 20 patients; one disputed terminating the pregnancy and was not included in the research. The remaining 19 patients, with a median age of 34 years, received intragestational sac methotrexate injection under ultrasound guidance. 7w3d was the median gestational age. These women had one to four previous caesarean sections, with a mean of 1.60±9. Patients with caesarean scar pregnancy most typically presented with spotting (42.1%), whereas 26.3% were asymptomatic. Except in cases of pain, the symptomatic women's HCG levels were lower than in the non-symptomatic women. The level of HCG in patients with pain was approximately double that of non-pain patients (p=0.2557). In our series, intragestational sac methotrexate injection was effective in 17/19 women, or 89.5% (95%CI: 75.7-100%). HCG levels were undetectable in 97.6±30 days on average (minimum: 42 days, maximum: 147 days). Conclusion Caesarean scar pregnancy is a rare possibly fatal condition with no consensus on the optimal treatment. An experienced Early Pregnancy Unit member performing local methotrexate injections under ultrasound guidance is a feasible and successful strategy in clinically stable patients.
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Affiliation(s)
- Angeliki Rouvalis
- Obstetrics and Gynecology, National and Kapodistrian University of Athens - 1st Obstetrics and Gynecology Clinic, Athens, Greece
| | - Panagiotis Vlastarakos
- Obstetrics and Gynecology, National and Kapodistrian University of Athens - 1st Obstetrics and Gynecology Clinic, Athens, Greece
| | - Georgios Daskalakis
- Obstetrics and Gynecology, National and Kapodistrian University of Athens - 1st Obstetrics and Gynecology Clinic, Athens, Greece
| | - Abraham Pouliakis
- 2nd Department of Pathology, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Sofoklis Stavrou
- First Department of Obstetrics and Gynecology, University of Athens, Greece, National and Kapodistrian University of Athens - 1st Obstetrics and Gynecology Clinic, Athens, Greece
| | - Maria Tsiriva
- First Department of Obstetrics and Gynecology, University of Athens, Greece, National and Kapodistrian University of Athens - 1st Obstetrics and Gynecology Clinic, Athens, Greece
| | - Maria Giourga
- First Department of Obstetrics and Gynecology, University of Athens, Greece, National and Kapodistrian University of Athens - 1st Obstetrics and Gynecology Clinic, Athens, Greece
| | - Angeliki Gerede
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Kalliopi Pappa
- First Department of Obstetrics and Gynecology, University of Athens, Greece, National and Kapodistrian University of Athens - 1st Obstetrics and Gynecology Clinic, Athens, Greece
| | - Themos Gregoriadis
- First Department of Obstetrics and Gynecology, University of Athens, Greece, National and Kapodistrian University of Athens - 1st Obstetrics and Gynecology Clinic, Athens, Greece
| | - Dimitrios-Efthymios Vlachos
- First Department of Obstetrics and Gynecology, University of Athens, Greece, National and Kapodistrian University of Athens - 1st Obstetrics and Gynecology Clinic, Athens, Greece
| | - Alexandros Rodolakis
- First Department of Obstetrics and Gynecology, University of Athens, Greece, National and Kapodistrian University of Athens - 1st Obstetrics and Gynecology Clinic, Athens, Greece
| | - Ekaterini Domali
- First Department of Obstetrics and Gynecology, University of Athens, Greece, National and Kapodistrian University of Athens - 1st Obstetrics and Gynecology Clinic, Athens, Greece
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Jordans IPM, Verberkt C, De Leeuw RA, Bilardo CM, Van Den Bosch T, Bourne T, Brölmann HAM, Dueholm M, Hehenkamp WJK, Jastrow N, Jurkovic D, Kaelin Agten A, Mashiach R, Naji O, Pajkrt E, Timmerman D, Vikhareva O, Van Der Voet LF, Huirne JAF. Definition and sonographic reporting system for Cesarean scar pregnancy in early gestation: modified Delphi method. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:437-449. [PMID: 34779085 PMCID: PMC9322566 DOI: 10.1002/uog.24815] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 10/30/2021] [Accepted: 11/05/2021] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To develop a standardized sonographic evaluation and reporting system for Cesarean scar pregnancy (CSP) in the first trimester, for use by both general gynecology and expert clinics. METHODS A modified Delphi procedure was carried out, in which 28 international experts in obstetric and gynecological ultrasonography were invited to participate. Extensive experience in the use of ultrasound to evaluate Cesarean section (CS) scars in early pregnancy and/or publications concerning CSP or niche evaluation was required to participate. Relevant items for the detection and evaluation of CSP were determined based on the results of a literature search. Consensus was predefined as a level of agreement of at least 70% for each item, and a minimum of three Delphi rounds were planned (two online questionnaires and one group meeting). RESULTS Sixteen experts participated in the Delphi study and four Delphi rounds were performed. In total, 58 items were determined to be relevant. We differentiated between basic measurements to be performed in general practice and advanced measurements for expert centers or for research purposes. The panel also formulated advice on indications for referral to an expert clinic. Consensus was reached for all 58 items on the definition, terminology, relevant items for evaluation and reporting of CSP. It was recommended that the first CS scar evaluation to determine the location of the pregnancy should be performed at 6-7 weeks' gestation using transvaginal ultrasound. The use of magnetic resonance imaging was not considered to add value in the diagnosis of CSP. A CSP was defined as a pregnancy with implantation in, or in close contact with, the niche. The experts agreed that a CSP can occur only when a niche is present and not in relation to a healed CS scar. Relevant sonographic items to record included gestational sac (GS) size, vascularity, location in relation to the uterine vessels, thickness of the residual myometrium and location of the pregnancy in relation to the uterine cavity and serosa. According to its location, a CSP can be classified as: (1) CSP in which the largest part of the GS protrudes towards the uterine cavity; (2) CSP in which the largest part of the GS is embedded in the myometrium but does not cross the serosal contour; and (3) CSP in which the GS is partially located beyond the outer contour of the cervix or uterus. The type of CSP may change with advancing gestation. Future studies are needed to validate this reporting system and the value of the different CSP types. CONCLUSION Consensus was achieved among experts regarding the sonographic evaluation and reporting of CSP in the first trimester. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- I. P. M. Jordans
- Department of Obstetrics and Gynecology, Research Institute “Amsterdam Reproduction and Development”, Amsterdam UMClocation VU Medical CenterAmsterdamThe Netherlands
| | - C. Verberkt
- Department of Obstetrics and Gynecology, Research Institute “Amsterdam Reproduction and Development”Amsterdam UMC, location AMCAmsterdamThe Netherlands
| | - R. A. De Leeuw
- Department of Obstetrics and Gynecology, Research Institute “Amsterdam Reproduction and Development”Amsterdam UMC, location AMCAmsterdamThe Netherlands
- Department of Obstetrics and GynecologyAmsterdam UMC, location AMCAmsterdamThe Netherlands
| | - C. M. Bilardo
- Department of Obstetrics and Gynecology, Amsterdam UMClocation VU Medical CenterAmsterdamThe Netherlands
| | - T. Van Den Bosch
- Department of Obstetrics and GynecologyUniversity Hospitals KU LeuvenLeuvenBelgium
- Laboratory for Tumor Immunology and ImmunotherapyKU LeuvenLeuvenBelgium
| | - T. Bourne
- Department of Obstetrics and GynecologyImperial College LondonLondonUK
| | - H. A. M. Brölmann
- Department of Obstetrics and Gynecology, Research Institute “Amsterdam Reproduction and Development”Amsterdam UMC, location AMCAmsterdamThe Netherlands
| | - M. Dueholm
- Department of Obstetrics and GynecologyAarhus University HospitalAarhusDenmark
| | - W. J. K. Hehenkamp
- Department of Obstetrics and Gynecology, Research Institute “Amsterdam Reproduction and Development”Amsterdam UMC, location AMCAmsterdamThe Netherlands
- Department of Obstetrics and GynecologyAmsterdam UMC, location AMCAmsterdamThe Netherlands
| | - N. Jastrow
- Department of Obstetrics and GynecologyHôpitaux Universitaires de GenèveGenevaSwitzerland
| | - D. Jurkovic
- Department of Obstetrics and GynecologyUniversity College HospitalLondonUK
| | - A. Kaelin Agten
- Department of Obstetrics and Gynecology, Nottingham University Hospitals NHSQueen's Medical CentreNottinghamUK
| | - R. Mashiach
- Department of Obstetrics and GynecologySheba Medical CenterRamat GanIsrael
- Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - O. Naji
- Department of Obstetrics and GynecologyImperial College LondonLondonUK
| | - E. Pajkrt
- Department of Obstetrics and GynecologyAmsterdam UMC, location AMCAmsterdamThe Netherlands
| | - D. Timmerman
- Department of Obstetrics and GynecologyUniversity Hospitals KU LeuvenLeuvenBelgium
| | - O. Vikhareva
- Department of Obstetrics and Gynecology, Skåne University Hospital MalmöLund UniversityMalmöSweden
| | - L. F. Van Der Voet
- Department of Obstetrics and GynecologyDeventer HospitalDeventerThe Netherlands
| | - J. A. F. Huirne
- Department of Obstetrics and Gynecology, Research Institute “Amsterdam Reproduction and Development”, Amsterdam UMClocation VU Medical CenterAmsterdamThe Netherlands
- Department of Obstetrics and Gynecology, Research Institute “Amsterdam Reproduction and Development”Amsterdam UMC, location AMCAmsterdamThe Netherlands
- Department of Obstetrics and GynecologyAmsterdam UMC, location AMCAmsterdamThe Netherlands
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Fang S, Zhang P, Zhu Y, Wang F, He L. A Retrospective Analysis of the Treatment of Cesarean Scar Pregnancy by High-Intensity Focused Ultrasound, Uterine Artery Embolization and Surgery. Front Surg 2020; 7:23. [PMID: 32671091 PMCID: PMC7326062 DOI: 10.3389/fsurg.2020.00023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 04/02/2020] [Indexed: 12/18/2022] Open
Abstract
Objective: This study aims to retrospectively analyze the clinical curative effects of surgery, uterine artery embolization (UAE), and high-intensity focused ultrasound (HIFU) in order to provide the theory and evidences for selecting the optimal treatment for cesarean scar pregnancy (CSP). Methods: Women with CSP were treated with surgery (laparoscopic, hysteroscopy, and hysteroscopy–laparoscopic surgery), UAE combined with curettage, and HIFU combined with curettage. The general conditions and therapeutic effects, including vital signs during the operation, discomfort of discharge, cure rate, total blood loss, decline in the rate of hCG, and hospital stay, were compared and analyzed. Results: For the 154 CSP patients, the cure rate of surgery (n = 95) was 97.89%, the cure rate of UAE (n = 32) was 43.74%, and the cure rate of HIFU (n = 27) was 70.37%. The difference was statistically significant (P < 0.05). Furthermore, the hCG level of surgical patients quickly declined, whereas HIFU slowly declined. The difference between the decline rate of hCG and mean hospitalization time was statistically significant (P < 0.05). UAE was good for CSP with gestational age <60 days and diameter of gestational sac <40 mm. Furthermore, HIFU was well for CSP patients with a gestational age of <55 days and a gestational sac diameter of <30 mm. Surgery was suitable for any type of these cases. Conclusion: CSP patients with short gestational age and small gestational sac can be treated with surgery, UAE, and HIFU, and achieve safe and effective therapeutic effects. Surgery is also a good choice for CSP for patients with a long gestational age, a large gestational sac diameter, high levels of hCG, or an ample blood supply.
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Affiliation(s)
- Shanyu Fang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ping Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Jiujiang University Hospital, Jiujiang University Clinical Medical College, Jiujiang, China
| | - Yuanfang Zhu
- Department of Obstetrics and Gynecology, Baoan Maternal and Child Health Hospital, Shenzhen, China
| | - Fen Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Linsheng He
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Drever N, Bertolone J, Shawki M, Janssens S. Caesarean scar ectopic pregnancy: Experience from an Australian tertiary centre. Aust N Z J Obstet Gynaecol 2020; 60:330-335. [PMID: 31944267 DOI: 10.1111/ajo.13119] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 11/23/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Despite the rising incidence of caesarean scar pregnancy (CSP), as yet there are no consensus or evidence-based guidelines for management. AIMS To review diagnosis, treatment and management of all women with CSP over a 5 year period at Mater Mothers' Hospital, Brisbane, Australia. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Natalie Drever
- Department of Obstetrics and Gynaecology, Mater Mothers' Hospital, Brisbane, Queensland, Australia
| | - Julia Bertolone
- Early Pregnancy Assessment Unit, Mater Mother's Hospital, Brisbane, Queensland, Australia
| | - Marwan Shawki
- Department of Obstetrics and Gynaecology, Mater Mothers' Hospital, Brisbane, Queensland, Australia
| | - Sarah Janssens
- Department of Obstetrics and Gynaecology, Mater Mothers' Hospital, Brisbane, Queensland, Australia.,Mater Education, Mater Hospital, Brisbane, Queensland, Australia
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Liu D, Gu X, Liu F, Shi F, Yang M, Wu Q. Application of contrast-enhanced ultrasound for scar pregnancy cases misdiagnosed as other diseases. Clin Chim Acta 2019; 496:134-139. [PMID: 31173731 DOI: 10.1016/j.cca.2019.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/31/2019] [Accepted: 06/04/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To demonstrate the feasibility of utilizing contrast-enhanced ultrasound (CEUS) in scar pregnancies misdiagnosed by transvaginal ultrasound (TVS). METHODS CEUS was performed in three patients with clinically suspected abnormal pregnancy, and the diagnosis were inconclusive by TVS. Clinical manifestations and features of TVS and CEUS in these cases were analyzed. RESULTS Three cases included an intramural pregnancy (IMP) after hysteromyomectomy, and two mass-based cesarean scar pregnancy (CSP), the mass was caused by curettage and spontaneous abortion, respectively. In all these cases, early enhancement with high intensity was observed by CEUS at the site of implantation. Moreover, prominently enhanced signal was detected inside the mass, with or without peritrophoblastic ring. No enhancement was detected in clots or masses after effective treatment. CONCLUSION CEUS can be used as a supplementary method to diagnose scar pregnancy and evaluate the treatment efficacy, especially in cases with ambiguous results by TVS.
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Affiliation(s)
- Dongmei Liu
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
| | - Xiaoning Gu
- Department of Ultrasound, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Fang Liu
- Department of Ultrasound, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Fuwen Shi
- Department of Ultrasound, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Min Yang
- Department of Ultrasound, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
| | - Qingqing Wu
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.
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Buskmiller C. The Ethics of Interstitial and Cesarean Scar Ectopic Pregnancies: Four Case Studies and a Review of the Literature. LINACRE QUARTERLY 2018; 85:252-269. [PMID: 30275610 PMCID: PMC6161235 DOI: 10.1177/0024363918788858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Catholic bioethicists have extensively addressed extrauterine tubal pregnancies, which represent the great majority of ectopic pregnancies. However, additional management options have been developed for the other 7-10 percent of ectopic pregnancies. Using two cases of interstitial pregnancy and two cases of cesarean scar pregnancy (CSP) seen at a Catholic tertiary care center, this article discusses options including expectant management, systemic methotrexate, intragestational methotrexate, intragestational potassium chloride, uterine artery embolization, dilation and curettage (D&C), vasopressin use, cornuostomy, cornual wedge resection, CSP evacuation, CSP scar excision, CSP salvage, and hysterectomy. Cornual wedge resection, vasopressin use, and CSP scar excision are morally acceptable; less clearly licit are aspiration of gestational sac contents, cornuostomy, gestational excision for CSPs, and methotrexate. Certainly illicit are any techniques leading to direct abortion such as D&Cs on live embryos or fetuses, double-balloon catheter placement, and use of potassium chloride. Summary: An ectopic pregnancy is any pregnancy outside the uterus. These are dangerous because the pregnancy can burst out of its abnormal location and cause life-threatening internal bleeding. Most are in the part of the fallopian tube outside the uterus, but there are other types, including interstitial pregnancies (located in the part of the tube tunneling through the uterine wall) and cesarean scar pregnancies (buried in the uterine scar where the cut for a C-section was made). This article lists the ways that physicians prevent women from dying from interstitial and cesarean scar pregnancies and proposes which treatments are morally acceptable.
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Affiliation(s)
- Cara Buskmiller
- Department of Obstetrics, Gynecology, and Women’s Health, St. Louis University, St. Louis, MO, USA
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