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Pomorski M, Sieroszewski P. Editorial: Management and prevention of long-term complications related to the niche in the uterine cesarean section scar. Front Surg 2024; 11:1381449. [PMID: 38450053 PMCID: PMC10915246 DOI: 10.3389/fsurg.2024.1381449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 02/13/2024] [Indexed: 03/08/2024] Open
Affiliation(s)
- Michał Pomorski
- II Department of Gynecology and Obstetrics, Wroclaw Medical University, Wrocław, Poland
| | - Piotr Sieroszewski
- Department of Fetal Medicine and Gynecology, Medical University of Lodz, Łódź, Poland
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Huang J, He P, Li D, Zhou J. Predictive factors analysis of cesarean scar pregnancy treated by local injection of Lauromacrogol combined with curettage. Medicine (Baltimore) 2023; 102:e32783. [PMID: 36705381 PMCID: PMC9876022 DOI: 10.1097/md.0000000000032783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
To explore factors related to local injection of Lauromacrogol combined with curettage in the treatment of cesarean scar pregnancy. A total of 24 successful and 8 unsuccessful cases were included. The age, gravidity, parity, times of cesarean section, interval from the last cesarean section, preoperative human chorionic gonadotropin (HCG), HCG on the first day after operation, decreasing rate of HCG on the first day after operation, average diameter of gestational sac, and preoperative vaginal bleeding days were analyzed. There were no significant differences of age, gravidity, parity, previous cesarean section times between groups. The differences of preoperative HCG, HCG on the first day after operation, the decreasing rate of HCG, gestational sac diameter, preoperative vaginal bleeding days were statistically significant between groups. The interval from the last cesarean section and the decreasing rate of HCG were protective factors, while the mean diameter of gestational sac and period of vaginal bleeding before operation were risk factors for the success of the treatment. The mean diameter of gestational sac owned the best predictive value.
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Affiliation(s)
- Jianxia Huang
- Gynecology Department, The Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, Zhejiang, China
- * Correspondence: Jianxia Huang, Gynecology Department, The Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, Zhejiang 310000, China (e-mail: )
| | - Pei He
- Department of Obstetrics, Hangzhou Women’s Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, Zhejiang, China
| | - Dingheng Li
- Department of Gynecology, Hangzhou Women’s Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, Zhejiang, China
| | - Jianwei Zhou
- Gynecology Department, The Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, Zhejiang, China
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Mori KH, Tavares BV, Yela DA, Baccaro LFC, Juliato CRT. Experience of a Tertiary Service in the Treatment of Women with Cervical Pregnancy. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:1014-1020. [PMID: 36580946 PMCID: PMC9800062 DOI: 10.1055/s-0042-1757954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Cervical pregnancy is challenging for the medical community, as it is potentially fatal. The treatment can be medical or surgical; however, there are no protocols that establish the best option for each case. The objective of the present study was to describe the cases of cervical pregnancy admitted to a tertiary university hospital over a period of 18 years. METHODS A retrospective study based on a review of the medical records of all cervical pregnancies admitted to the Women's Hospital at Universidade Estadual de Campinas, Southeastern Brazil, from 2000 to 2018. RESULTS We identified 13 cases of cervical pregnancy out of a total of 673 ectopic pregnancies; only 1 case was initially treated with surgery because of hemodynamic instability. Of the 12 cases treated conservatively, 7 were treated with single-dose intramuscular methotrexate, 1, with intravenous and intramuscular methotrexate, 1, with intravenous methotrexate, 1, with 2 doses of intramuscular methotrexate, and 2, with intra-amniotic methotrexate. Of these cases, one had a therapeutic failure that required a hysterectomy. Two women received blood transfusions. Four women required cervical tamponade with a Foley catheter balloon for hemostasis. There was no fatal outcome. CONCLUSION Cervical pregnancy is a rare and challenging condition from diagnosis to treatment. Conservative treatment was the primary method of therapy used, with satisfactory results. In cases of increased bleeding, cervical curettage was the initial treatment, and it was associated with the use of a cervical balloon for hemostasis.
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Affiliation(s)
| | | | | | | | - Cassia Raquel Teatin Juliato
- Universidade Estadual de Campinas, Campinas, SP, Brazil,Address for correspondence Cássia Raquel Teatin Juliato Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881Brazil
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4
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Ye JP, Gao Y, Lu LW, Ye YJ. Effectiveness and safety of ultrasound-guided intramuscular lauromacrogol injection combined with hysteroscopy in cervical pregnancy treatment: A case report. World J Clin Cases 2022; 10:6128-6135. [PMID: 35949833 PMCID: PMC9254199 DOI: 10.12998/wjcc.v10.i18.6128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/07/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cervical pregnancy is increasing in morbidity, and a definite diagnosis in early stages is challenging due to its specific onset site. Surgery is the mainstay of treatment for cervical pregnancy, but it may result in the loss of natural fertility. Therefore, it is a great challenge to pursue a safe and effective treatment for cervical pregnancy.
CASE SUMMARY We report the case of a cervical pregnancy successfully treated by ultrasound-guided cervical-intramuscular lauromacrogol injection combined with hysteroscopy. A 23-year-old woman with minor irregular vaginal bleeding was admitted to our department with suspected ectopic pregnancy. Transvaginal ultrasound revealed a gestational sac (approximately 22 mm x 13 mm) situated in the cervical canal with a yolk sac and blood flow signals. No cardiac activity was detected. Serum beta progesterone was 17.06 ng/mL, and serum beta human chorionic gonadotropin (β-HCG) was 5077.0 IU/L. The patient was diagnosed with cervical pregnancy. She was treated by ultrasound-guided cervical-intramuscular injections of lauromacrogol (3 mL) in combination with aborting under hysteroscopic visualization. A gradual decrease in β-HCG levels and normal ultrasound findings were observed. Postoperative pathologic examination showed the presence of villi and changes in the endometrium in the secretory phase. The patient was discharged on day 6, and her β-HCG level was 0.67 mIU/mL after 1 wk. There was no statistical difference between baseline and 1-week postoperative data in terms of serum indices including liver function, renal function, and routine blood analysis after treatment. The patient subsequently became pregnant 2 mo later and no abnormalities were detected on routine screening during pregnancy.
CONCLUSION Ultrasound-guided cervical-intramuscular lauromacrogol injection combined with hysteroscopy may be effective and safe in the treatment of cervical pregnancy.
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Affiliation(s)
- Jian-Pei Ye
- Department of Ultrasonography, Lishui Hospital of Traditional Chinese Medicine, Lishui 323000, Zhejiang Province, China
| | - Yang Gao
- Department of Gynaecology, Lishui Hospital of Traditional Chinese Medicine, Lishui 323000, Zhejiang Province, China
| | - Li-Wei Lu
- Department of Gynaecology, Lishui Hospital of Traditional Chinese Medicine, Lishui 323000, Zhejiang Province, China
| | - Yong-Ju Ye
- Department of Gynaecology, Lishui Hospital of Traditional Chinese Medicine, Lishui 323000, Zhejiang Province, China
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Valasoulis G, Magaliou I, Koufidis D, Garas A, Daponte A. Caesarean Scar Pregnancy: A Case Report and a Literature Review. Medicina (B Aires) 2022; 58:medicina58060740. [PMID: 35744003 PMCID: PMC9227540 DOI: 10.3390/medicina58060740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/21/2022] [Accepted: 05/25/2022] [Indexed: 01/29/2023] Open
Abstract
Background and Objectives: Caesarean scar pregnancy (CSP) refers to placental implantation on or in the scar of a previous caesarean section and represents a potentially life-threatening condition. CSP is considered a diagnostic challenge in obstetrics, with the diagnosis relying mainly on transvaginal ultrasound (TVS) and the management depending upon case presentation and available healthcare infrastructures. Case Presentation: We present a case of 34-year-old G3P2 with a history of two-previous caesarean sections referred to the outpatient gynaecology clinic of our Department at the 7th week (7/40) of gestation with abnormal early pregnancy TVS findings, illustrating the gestational sac attached to the caesarean scar and a foetal pole with evidence of foetal cardiac activity. We discuss the outcome of an alternative combined medical and surgical approach we followed as well as an updated review of the current literature. Conclusions: The ideal management of CSP requires tertiary centers, equipment availability and experienced healthcare professionals capable of dealing with any possible complication, as well as individualized treatment based on each case presentation.
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Affiliation(s)
- George Valasoulis
- Department of Obstetrics & Gynaecology, University Hospital of Larisa, Mezourlo, 41334 Larisa, Greece; (G.V.); (I.M.); (D.K.); (A.G.)
- Hellenic National Public Health Organization-ECDC, Marousi, 15123 Athens, Greece
| | - Ioulia Magaliou
- Department of Obstetrics & Gynaecology, University Hospital of Larisa, Mezourlo, 41334 Larisa, Greece; (G.V.); (I.M.); (D.K.); (A.G.)
| | - Dimitrios Koufidis
- Department of Obstetrics & Gynaecology, University Hospital of Larisa, Mezourlo, 41334 Larisa, Greece; (G.V.); (I.M.); (D.K.); (A.G.)
| | - Antonios Garas
- Department of Obstetrics & Gynaecology, University Hospital of Larisa, Mezourlo, 41334 Larisa, Greece; (G.V.); (I.M.); (D.K.); (A.G.)
| | - Alexandros Daponte
- Department of Obstetrics & Gynaecology, University Hospital of Larisa, Mezourlo, 41334 Larisa, Greece; (G.V.); (I.M.); (D.K.); (A.G.)
- Correspondence: ; Tel.: +30-6974-368-889
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Yüksel Şimşek S, Şimşek E, Alkaş Yağınç D, Baran ŞY, Çok T, Bulgan Kılıçdağ E. Outcomes of cesarean scar pregnancy treatment: Do we have options? Turk J Obstet Gynecol 2021; 18:85-91. [PMID: 34082520 PMCID: PMC8191324 DOI: 10.4274/tjod.galenos.2021.77535] [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] [Indexed: 12/01/2022] Open
Abstract
Objective: To investigate the success and complications of medical and surgical modalities used in the treatment of cesarean scar pregnancies. Materials and Methods: Medical and surgical approaches that have been used to treat cesarean scar pregnancies were evaluated retrospectively, Local, systemic, and combined methotrexate treatments were grouped as the medical approach, and dilatation and evacuation, hysteroscopic resection, laparoscopic and laparotomic approaches were grouped as the surgical approach. Fifty-three patients were diagnosed as having cesarean scar pregnancy during the study period, 48 of whom were included in the final analysis. Eighteen patients were treated with medical interventions and 30 patients were treated surgically. Results: The success rate of surgical modalities was 96.6% and the medical treatment success was 33% (p<0.001). The complication rate was higher with medical approaches compared with surgical methods (66% vs 3.3%, respectively; p<0.001). Conclusion: Surgical intervention seems safer and more successful than medical treatment.
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Affiliation(s)
- Seda Yüksel Şimşek
- Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Application Center, Clinic of Obstetrics and Gynecology, Adana, Turkey
| | - Erhan Şimşek
- Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Application Center, Clinic of Obstetrics and Gynecology, Adana, Turkey
| | - Didem Alkaş Yağınç
- Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Application Center, Clinic of Obstetrics and Gynecology, Adana, Turkey
| | - Şafak Yılmaz Baran
- Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Application Center, Clinic of Obstetrics and Gynecology, Adana, Turkey
| | - Tayfun Çok
- Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Application Center, Clinic of Obstetrics and Gynecology, Adana, Turkey
| | - Esra Bulgan Kılıçdağ
- Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Application Center, Clinic of Obstetrics and Gynecology, Adana, Turkey
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Timor-Tritsch I, Buca D, Di Mascio D, Cali G, D'Amico A, Monteagudo A, Tinari S, Morlando M, Nappi L, Greco P, Rizzo G, Liberati M, Jose-Palacios-Jaraquemada, D'Antonio F. Outcome of cesarean scar pregnancy according to gestational age at diagnosis: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021; 258:53-59. [PMID: 33421811 DOI: 10.1016/j.ejogrb.2020.11.036] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/11/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The association between the most severe types of placenta accreta spectrum disorders and caesarean scar pregnancy (CSP) poses the question of whether early diagnosis may impact the clinical outcome of these anomalies. The aim of this study is to report the outcome of cesarean scar pregnancy (CSP) diagnosed in the early (≤9 weeks) versus late (>9 weeks) first trimester of pregnancy. STUDY DESIGN Medline, Embase and Clinicaltrail.gov databases were searched. Studies including cases of CSP with an early (≤9 weeks of gestation) compared to a late (>9 weeks) first trimester diagnosis of CSP, followed by immediate treatment, were included in this systematic review. The primary outcome was a composite measure of severe maternal morbidity including either severe first trimester bleeding, need for blood transfusion, uterine rupture or emergency hysterectomy. The secondary outcomes were the individual components of the primary outcome. Random-effect meta-analyses were used to combine data. RESULTS Thirty-six studies (724 women with CSP) were included. Overall, composite adverse outcome complicated 5.9 % (95 % CI 3.5-9.0) of CSP diagnosed ≤9 weeks and 32.4 % (95 % CI 15.7-51.8) of those diagnosed >9 weeks. Massive hemorrhage occurred in 4.3 % (95 % CI 2.3-7.0) of women with early and in 28.0 % (95 % CI 14.1-44.5) of those with late first trimester diagnosis of CSP, while the corresponding figures for the need for blood transfusion were 1.5 % (95 % CI 0.6-2.8) and 15.8 % (95 % CI 5.5-30.2) respectively. Uterine rupture occurred in 2.5 % (95 % CI 1.2-4.1) of women with a prenatal diagnosis of CSP ≤ 9 weeks and in 7.5 % (95 % CI 2.5-14.9) of those with CSP > 9 weeks, while an emergency intervention involving hysterectomy was required in 3.7 % (95 % CI 2.2-5.4) and 16.3 % (95 % CI5.9-30.6) respectively. When computing the risk, early diagnosis of CSP was associated with a significantly lower risk of composite adverse outcome, (OR: 0.14; 95 % CI 0.1-0.4 p < 0.001). CONCLUSIONS Early first trimester diagnosis of CSP is associated with a significantly lower risk of maternal complications, thus supporting a policy of universal screening for these anomalies in women with a prior cesarean delivery although the cost-effectiveness of such policy should be tested in future studies.
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Affiliation(s)
- Ilan Timor-Tritsch
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, New York University SOM, New York, NY, USA
| | - Danilo Buca
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Daniele Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Giuseppe Cali
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Villa Sofia Cervello, Palermo, Italy
| | - Alice D'Amico
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Ana Monteagudo
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sara Tinari
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Maddalena Morlando
- Department of Woman, Child, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luigi Nappi
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynaecology, University of Foggia, Italy
| | - Pantaleo Greco
- Department of Morphology, Surgery and Experimental Medicine, Institute of Obstetrics and Gynaecology, University of Ferrara, Italy
| | - Giuseppe Rizzo
- Università di Roma Tor Vergata, Division of Maternal Fetal Medicine, Ospedale Cristo Re, Rome, Italy; The First I.M. Sechenov Moscow State Medical University, Department of Obstetrics and Gynecology, Moscow, Russia
| | - Marco Liberati
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Jose-Palacios-Jaraquemada
- Centre for Medical Education and Clinical Research (CEMIC), University Hospital, Buenos Aires, Argentina
| | - Francesco D'Antonio
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy.
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