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Liu S, Liu X, Chen Q, Zhao M, Tang Y. Potential Risk Factors for Developing Cesarean Scar Pregnancy in Women With a History of Cesarean Section. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024. [PMID: 39387635 DOI: 10.1002/jum.16599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 08/14/2024] [Accepted: 09/25/2024] [Indexed: 10/15/2024]
Abstract
OBJECTIVES Cesarean scar pregnancy (CSP) occurs in 0.2%-0.5% of women with a previous cesarean section globally. Multiple factors influence the development of CSP; however, to date, the critical factors contributing to the development of CSP have not been fully explored due to its relatively low incidence. Moreover, CSP can be clinically categorized into type 1 and type 2 CSP. In this retrospective study with a large sample size, we investigated potential risk factors that could contribute to CSP development. METHODS Two hundred-one women diagnosed with CSP, either type 1 or type 2 CSP, and 1700 pregnant women with a history of cesarean section but without CSP diagnosis in subsequent pregnancy were included. Gravidity, previous live birth(s), consecutive cesarean section(s), surgical abortion(s), the interval between the pregnancies, and maternal age were compared between the 2 groups. RESULTS Gravidity, the number of previous live births, the number of previous consecutive cesarean sections, and the number of surgical abortions were significantly associated with CSP development in women with a past cesarean section. This association was regardless of the subtypes of CSP. Notably, the interval between 2 pregnancies was also significantly associated with CSP development, but this association was only seen in type 2 CSP. However, maternal age was not an independent risk factor for CSP development. Additionally, a higher incidence of CSP was observed in China compared to that reported in the literature. CONCLUSION In addition to a previous cesarean section, our study highlights at the number of surgical abortions also contributes to the development of CSP.
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Affiliation(s)
- Shurong Liu
- Department of Gynaecology, Obstetrics and Gynaecology Hospital, Fudan University of China, Shanghai, China
| | - Xiaqin Liu
- Department of Family Planning, Obstetrics and Gynaecology Hospital, Fudan University of China, Shanghai, China
| | - Qi Chen
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Min Zhao
- Department of Gynaecology, Wuxi Maternity and Child Health Hospital, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Yunhui Tang
- Department of Family Planning, Obstetrics and Gynaecology Hospital, Fudan University of China, Shanghai, China
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Abdullah NA. Outcome and treatment of cesarean scar ectopic pregnancy under ultrasound-guided vacuum aspiration. J Int Med Res 2024; 52:3000605241281692. [PMID: 39351993 DOI: 10.1177/03000605241281692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2024] Open
Abstract
OBJECTIVE This study aimed to describe cases of cesarean scar pregnancies that were successfully treated with suction curettage under ultrasound guidance and their outcome. METHODS This retrospective, descriptive case-series study was performed on 17 patients diagnosed with cesarean scar ectopic pregnancy in Sulaimani Maternity Teaching Hospital from May 2022 to April 2023. The patients' sociodemographic and clinical data were collected. The patients were treated with suction curettage alone or in combination with local injection of methotrexate under ultrasound guidance. RESULTS Patients with a viable fetus (n = 4) received local intrinsic methotrexate injection into the gestational sac and suction curettage, while those in whom the fetus had died (n = 13) underwent only suction curettage. Five patients required intrauterine balloon insertion to stop bleeding without further treatment, and only three required a blood transfusion owing to severe bleeding. CONCLUSIONS Cesarean scar ectopic pregnancy is a dangerous and complex disorder with an increasing occurrence in recent years. Accurate early diagnosis and effective management are essential to reduce maternal mortality and mortality of this type of pregnancy.
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Affiliation(s)
- Naz Azad Abdullah
- Department of Clinical Sciences, College of Medicine, University of Sulaimani, Sulaimaniyah, Iraq
- Sulaimani Maternity Teaching Hospital, Directorate of Health, Sulaimaniyah, Iraq
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Chen Z, Wang M, Yang P, Yao B, Shuai H, Li P. Exaggerated placental site in a cesarean scar: Misdiagnosed as gestational trophoblastic neoplasia: A case report. Exp Ther Med 2024; 28:298. [PMID: 38868614 PMCID: PMC11168028 DOI: 10.3892/etm.2024.12587] [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: 01/13/2024] [Accepted: 04/26/2024] [Indexed: 06/14/2024] Open
Abstract
The present study reports a rare case of an exaggerated placental site (EPS) in a caesarean scar that was misdiagnosed as gestational trophoblastic neoplasia (GTN) by imaging, resulting in unnecessary surgical treatment. A 38-year-old woman underwent hysteroscopic resection of a cesarean scar pregnancy (CSP). The patient's serum β-human chorionic gonadotropin (β-hCG) level was elevated (76,196 mIU/ml) at the 24-day postoperative follow-up visit. On postoperative day 51, the patient experienced vaginal bleeding for three days and β-hCG levels were 2,799 mIU/ml. Ultrasonography and MRI revealed a heterogeneous mass and hypervascularity. The patient was diagnosed with a GTN in a cesarean scar and treated with methotrexate (MTX). β-hCG levels decreased after 3 MTX doses, but the mass did not change in size and was still hypervascular on imaging. Total hysterectomy was performed due to the serious side effects of chemotherapy and the lack of desire to preserve fertility. The histological findings supported the diagnosis of an EPS reaction. The present case is unique because of the rare intrauterine mass and possibility of retained trophoblastic changes causing EPS. EPS differs from GTN both clinically and pathologically and should be considered a possible diagnosis in any woman who has irregular bleeding following CSP resection.
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Affiliation(s)
- Zongbin Chen
- Department of Gynecology and Obstetrics, Jinan University First Affiliated Hospital, Guangzhou, Guangdong 510632, P.R. China
- Department of Pathology, Jinan University School of Medicine, Guangzhou, Guangdong 510632, P.R. China
| | - Minghua Wang
- Department of Pathology, Longgang District People's Hospital, Shenzhen, Guangdong 518172, P.R. China
| | - Ping Yang
- Department of Pathology, Longgang District People's Hospital, Shenzhen, Guangdong 518172, P.R. China
| | - Bo Yao
- Department of Pathology, Jinan University School of Medicine, Guangzhou, Guangdong 510632, P.R. China
| | - Hanlin Shuai
- Department of Gynecology and Obstetrics, Jinan University First Affiliated Hospital, Guangzhou, Guangdong 510632, P.R. China
| | - Ping Li
- Department of Pathology, Jinan University School of Medicine, Guangzhou, Guangdong 510632, P.R. China
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Saadia Z, Nasralla K, Iqbal J, Elamin E. Prevalence, Determinants, and Management Options of Scar Site Pregnancy in Women With Previous Cesarean Section: A Study From the Al-Qassim Region. Cureus 2024; 16:e65874. [PMID: 39219911 PMCID: PMC11364361 DOI: 10.7759/cureus.65874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION Pregnancy located outside the uterine cavity following a cesarean section has become more prevalent in recent years due to the increase in cesarean section delivery. This study sought to investigate the prevalence, determinants, and treatment options of scar site pregnancy among women who sought maternal and child health services in a hospital in Buraydah, Al-Qassim region, Saudi Arabia. METHODS Utilizing a quantitative retrospective case-control design, 50 women were recruited and assigned to the two groups evenly. Demographic data and risk factors were assessed using a questionnaire, and data were analyzed using SPSS version 27 at a 95% confidence interval and presented in tables and figures. RESULTS Fifty-eight percent of the participants were aged 35 years and above, with 38% reporting a parity of 1-3. Logistic regression revealed that parity (odds ratio (OR) = 10.975, 95% confidence interval (CI) = 0.887-135.861, and p-value = 0.062), the interval between the last and present pregnancies (OR = 0.056, 95% CI = 0.005-0.668, p-value = 0.023), intrauterine contraceptive device (IUCD) use in the last year (OR = 0.070, 95% CI = 0.006 -0.780, p-value = 0.031) were statistically significant in predicting cesarean scar pregnancy. Combined methotrexate and aspiration were the most prevalent treatment options for scar site pregnancy in this study. CONCLUSION Scar site pregnancy is a maternal health complication that affects women across all healthcare settings, and its prevalence is not clear due to underdiagnosis and underreporting. The risk of scar site pregnancy increased with an increase in the number of childbirths (parity) and the interval between the last and current pregnancies.
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Affiliation(s)
- Zaheera Saadia
- Obstetrics and Gynecology, Qassim University, College of Medicine, Buraydah, SAU
| | - Khalid Nasralla
- Obstetrics and Gynecology, Qassim University, College of Medicine, Buraydah, SAU
| | - Javed Iqbal
- Obstetrics and Gynecology, Maternity and Children Hospital, Buraydah, SAU
| | - Ebtihal Elamin
- Obstetrics and Gynecology, Maternity and Children Hospital, Buraydah, SAU
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Lei Y, Du X, Liu Y, Le F, Zhou J. Surgical treatment and reproductive outcomes in caesarean scar pregnancy at a single center. Reprod Biol Endocrinol 2024; 22:54. [PMID: 38734672 PMCID: PMC11088178 DOI: 10.1186/s12958-024-01225-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/01/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND To investigate factors associated with different reproductive outcomes in patients with Caesarean scar pregnancies (CSPs). METHODS Between May 2017 and July 2022, 549 patients underwent ultrasound-guided uterine aspiration and laparoscopic scar repair at the Gynaecology Department of Hubei Maternal and Child Health Hospital. Ultrasound-guided uterine aspiration was performed in patients with type I and II CSPs, and laparoscopic scar repair was performed in patients with type III CSP. The reproductive outcomes of 100 patients with fertility needs were followed up and compared between the groups. RESULTS Of 100 patients, 43% had live births (43/100), 19% had abortions (19/100), 38% had secondary infertility (38/100), 15% had recurrent CSPs (RCSPs) (15/100). The reproductive outcomes of patients with CSPs after surgical treatment were not correlated with age, body mass index, time of gestation, yields, abortions, Caesarean sections, length of hospital stay, weeks of menopause during treatment, maximum diameter of the gestational sac, thickness of the remaining muscle layer of the uterine scar, type of CSP, surgical method, uterine artery embolisation during treatment, major bleeding, or presence of uterine adhesions after surgery. Abortion after treatment was the only risk factor affecting RCSPs (odds ratio 11.25, 95% confidence interval, 3.302-38.325; P < 0.01) and it had a certain predictive value for RCSP occurrence (area under the curve, 0.741). CONCLUSIONS The recurrence probability of CSPs was low, and women with childbearing intentions after CSPs should be encouraged to become pregnant again. Abortion after CSP is a risk factor for RCSP. No significant difference in reproductive outcomes was observed between the patients who underwent ultrasound-guided uterine aspiration and those who underwent laparoscopic scar repair for CSP.
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Affiliation(s)
- Yan Lei
- Department of Gynecology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China.
| | - Xin Du
- Department of Gynecology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Yu Liu
- Department of Gynecology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Fangshu Le
- Department of Gynecology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Jianshan Zhou
- Department of Gynecology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
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Sharami SH, Arzpeyma SF, Montazeri S, Ghadim‐limudahi ZH, Eslami‐Kenarsari H, Attari SM, Kamakoli HT. Clinical and historical features of cesarean scar pregnancies in a tertiary hospital with a high rate of cesarean section: A case-control survey. Health Sci Rep 2024; 7:e1823. [PMID: 38328788 PMCID: PMC10847394 DOI: 10.1002/hsr2.1823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 12/12/2023] [Accepted: 01/04/2024] [Indexed: 02/09/2024] Open
Abstract
Background and Aims Cesarean scar pregnancy (CSP) is a rare medical condition accounting for 1:2000 of all pregnancies with prior history of cesarean deliveries (CS). As the rate of CS is increasing worldwide, it is important to know the nature of CSP and its complications. Methods In this retrospective case-control study, we evaluated 264 pregnant women; 86 cases with ultra-sonographic findings of CSP and 178 controls: normal pregnancies with gestational age less than 12 weeks. The variables consisted of demographic characteristics, the features and causes of the prior CS, the time distance to the current pregnancy, sonographic features, and the final management. All data analyzed using SPSS version 21. Results There was a significant difference between the two study groups regarding to parity, abortions and D&Cs (p < 0.001). In the case group, 19.8% of patients had positive results for STDs versus 16.3% in the control group (p > 0.990). The mean average of intervals between the last CS and current pregnancies were 48.22 ± 37.03 in the case group versus 61.25 ± 36.25 months in the control group (p < 0.001). Regression Logistic analysis showed advanced maternal age (p < 0.001), positive history of abortions and D&C (p < 0.001), elective type of prior c/s (p < 0.001) and the short time interval between prior CS and current pregnancy (p < 0.001) could significantly predict the patients at higher risk of presenting CSP in the case group. Conclusions Based on our findings, advanced maternal age, positive history of abortion, the elective type of the former CS, and short time intervals between previous CS and current pregnancy are the main risk factors of CSP.
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Affiliation(s)
- Seyedeh Hajar Sharami
- Obstetrics & Gynecology, Reproductive Health Research Center, Department of Obstetrics & Gynecology, Al‐zahra Hospital, School of MedicineGuilan University of Medical SciencesRashtIran
| | - Sima Fallah Arzpeyma
- Reproductive Health Research Center, Department of Obstetrics & Gynecology, Al‐zahra Hospital, School of MedicineGuilan University of Medical SciencesRashtIran
| | - Sina Montazeri
- Reproductive Health Research Center, Department of Obstetrics & Gynecology, Al‐zahra Hospital, School of MedicineGuilan University of Medical SciencesRashtIran
| | - Zahra Haghparast Ghadim‐limudahi
- Reproductive Health Research Center, Department of Obstetrics & Gynecology, Al‐zahra Hospital, School of MedicineGuilan University of Medical SciencesRashtIran
| | - Habib Eslami‐Kenarsari
- Epidemiology, Vice‐Chancellorship of Research and TechnologyGuilan University of Medical ScienceRashtIran
| | - Seyedeh Maryam Attari
- Midwifery, Reproductive Health Research Center, Al‐zahra HospitalGuilan University of Medical SciencesRashtIran
| | - Harir Tanhaye Kamakoli
- Midwifery, Reproductive Health Research Center, Al‐zahra HospitalGuilan University of Medical SciencesRashtIran
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Huang J, Phillips C, Moshiri M. Scarred for life: a review of cesarean section scar pregnancy and potential pitfalls in diagnosis. Abdom Radiol (NY) 2023; 48:2672-2683. [PMID: 37204508 DOI: 10.1007/s00261-023-03953-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/20/2023]
Abstract
Cesarean section scar pregnancy (CSSP) is defined as abnormal implantation of a gestational sac on or in a previous cesarean section scar. There is an increasing incidence of detection of CSSP, likely in part due to the growing rates of cesarean deliveries and the improved rates of detection with advancing ultrasound technology. Diagnosis of CSSP is critical due to the potentially life-threatening complications to the mother if left untreated. Pelvic ultrasound is the imaging modality of choice in the initial evaluation of suspected CSSP, with MRI potentially useful if ultrasound findings are equivocal, or if confirmation is requested prior to definitive intervention. Early and accurate diagnosis of CSSP allows for prompt management to avoid severe complications and the potential to preserve the uterus and future fertility. A combination of medical and surgical treatment strategies may be needed with specific therapy tailored to each patient. Follow-up after treatment should include serial beta-hCG levels and possible repeat imaging if there is clinical concern for complications or treatment failure. This article will provide a comprehensive review of this uncommon but important phenomenon, detailing the pathophysiology and types of CSSP, imaging presentations, potential pitfalls in diagnosis, and management options.
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Affiliation(s)
- Jennifer Huang
- Department of Radiology, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, USA.
- PGY-5 Chief Resident, Diagnostic Radiology Residency, Vanderbilt University Medical Center, 1161 21st Ave South, Nashville, TN, 37232, USA.
| | - Catherine Phillips
- Department of Radiology, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, USA
| | - Mariam Moshiri
- Department of Radiology, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, USA
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Tarafdari A, Bandarian M, Hantoushzadeh S, Hadizadeh A, Shahsavari S, alsadat Razavi M. Assessing the risk factors and management outcomes of ectopic pregnancy: A retrospective case-control study. Int J Reprod Biomed 2023; 21:403-414. [PMID: 37362094 PMCID: PMC10285197 DOI: 10.18502/ijrm.v21i5.13475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 07/19/2022] [Accepted: 11/15/2022] [Indexed: 06/28/2023] Open
Abstract
Background Ectopic pregnancy (EP) is the implantation of a fertilized egg outside the uterine cavity or in an unusual location. According to the clinical case reports, hormonal contraceptive failures may be related to emergency contraceptives and EP. EP may be treated medically, surgically, or expectantly. Currently, there is no consensus regarding whether a multiple- or double-dose regimen with methotrexate (MTX) or an additional dose could be more effective than a single-dose regimen. Objective This study aimed to assess risk factors and treatment outcomes for EP. Materials and Methods This case-control study was conducted in Tehran, Iran from March 2020 to March 2021. The case group was comprised of all EP-diagnosed cases (n = 191). Based on the levels of β-human chorionic gonadotropin, MTX was administered to stable individuals with no surgical indications. Risk factors were assessed through 2 control groups: intrauterine pregnancy (n = 190) and nonpregnant groups (n = 180). Results The medical treatment significantly improved with an extra dose of MTX, especially in individuals with higher β-human chorionic gonadotropin concentrations and gestational age > 7.5 wk (p = 0.002). Considering risk factors, it is assumed that hormonal contraceptive failures, including both oral and emergency contraceptives, may increase the EP likelihood (p < 0.001). Conclusion Based on our findings, we recommended an additional dose of MTX for subjects who are further along in their pregnancy. It is also concluded that failure of contraceptive pills increases the chances of EP.
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Affiliation(s)
- Azadeh Tarafdari
- Department of Obstetrics and Gynecology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahin Bandarian
- Department of Obstetrics and Gynecology, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sedigheh Hantoushzadeh
- Department of Obstetrics and Gynecology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Hadizadeh
- Research Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Diseases Research Center Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeedeh Shahsavari
- Department of Obstetrics and Gynecology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam alsadat Razavi
- Department of Obstetrics and Gynecology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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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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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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Shrestha AB, Shrestha S, Ovi AI, Ayesha T, Basak S, Soma MP, Parvin MI. Methotrexate therapy followed by laparotomy to manage a viable first-trimester cesarean scar ectopic pregnancy in a low-resource setting: A case report. Case Rep Womens Health 2022; 36:e00454. [PMID: 36267680 PMCID: PMC9576811 DOI: 10.1016/j.crwh.2022.e00454] [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: 09/21/2022] [Revised: 10/02/2022] [Accepted: 10/03/2022] [Indexed: 11/24/2022] Open
Abstract
Cesarean scar ectopic pregnancy (CSEP) is rare, occurring in 1:1800 to 1:2625 pregnancies. It is classified into two types: endogenous, which grows inside the uterine cavity; and exogenous, which grows outward, toward the bladder. Both types are associated with increased maternal morbidity and mortality. The case report describes a 25-year-old woman with a viable first-trimester CSEP treated with both methotrexate and operative resection. Management was in a low-resource setting. Cesarean scar ectopic pregnancy (CSEP) is rare. We report the management of a viable first-trimester CSEP in a low-resource setting. Management involved methotrexate followed by operative resection with laparotomy.
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Affiliation(s)
| | | | | | - Tasnim Ayesha
- Department of Gynecology and Obstetrics, M Abdur Rahim Medical College, Dinajpur, Bangladesh
| | - Sima Basak
- Department of Gynecology and Obstetrics, M Abdur Rahim Medical College, Dinajpur, Bangladesh
| | - Minara Parvin Soma
- Department of Gynecology and Obstetrics, M Abdur Rahim Medical College, Dinajpur, Bangladesh
| | - Mst. Irine Parvin
- Department of Gynecology and Obstetrics, M Abdur Rahim Medical College, Dinajpur, Bangladesh
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12
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Endometriosis and Isthmocele: Common or Rare? J Clin Med 2022; 11:jcm11051158. [PMID: 35268248 PMCID: PMC8911021 DOI: 10.3390/jcm11051158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/13/2022] [Accepted: 02/19/2022] [Indexed: 01/27/2023] Open
Abstract
Higher cesarean section rates and better ultrasound diagnostics have led to a more frequent diagnosis of isthmocele, a cesarean scar defect. Sometimes, endometriosis is found in the isthmocele, but simultaneous extrauterine endometriosis and endometriosis in the isthmocele have not yet been reported. Additionally, the surgical technique to repair the isthmocele is the subject of ongoing controversy. The aim of this study is to analyze a possible correlation between uterine scar (isthmocele) endometriosis and extrauterine endometriosis and to investigate the outcome of laparoscopic isthmocele resection in the rendezvous technique. In this single-center retrospective study, we included 83 women of reproductive age with symptomatic isthmocele undergoing laparoscopic isthmocele repair in rendezvous technique from 2004 to 2020 at the University of Bern. We collected data on patient and surgical characteristics as well as on postoperative outcomes (symptoms, further pregnancy, and pregnancy outcomes) retrospectively. We analyzed and compared these data for patients with and without endometriosis. Endometriosis was diagnosed during surgery in 22 out of 83 operated patients (26.5%). Diagnosis of isthmocele endometriosis (n = 9, 11%) was significantly higher in patients with extrauterine endometriosis (n = 6, p = 0.004). While the duration of surgery was significantly longer for patients with endometriosis (p = 0.006), the groups did not differ with regard to blood loss or complications. In addition, both groups showed similar indications for isthmocele repair (infertility, abnormal uterine bleeding, or dysmenorrhea). Surgery significantly improved abnormal uterine bleeding (χ2 p < 0.001), dysmenorrhea (χ2, p = 0.03), and infertility (χ2, p < 0.001). Regardless of the presence of endometriosis, 25 of 40 (63%) infertile patients became pregnant after surgery. In one out of eight pregnancies, however, we observed scar complications during pregnancy such as uterine scar pregnancy (n = 3), uterine scar dehiscence (n = 3), and placenta previa (n = 1). Endometriosis is a non-negligible intraoperative finding in patients with symptomatic isthmocele. The laparoscopic approach in the rendezvous technique is safe and effective. Therefore, this method should be recommended, especially in women with secondary infertility, and preoperatively simultaneous endometriosis resection should be discussed with the patient. In follow-up, postoperative pregnancies have to be monitored with care.
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13
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Cheng XL, Cao XY, Wang XQ, Lin HL, Fang JC, Wang L. Diagnosing early scar pregnancy in the lower uterine segment after cesarean section by intracavitary ultrasound. World J Clin Cases 2022; 10:547-553. [PMID: 35097080 PMCID: PMC8771384 DOI: 10.12998/wjcc.v10.i2.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/14/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Early scar pregnancy (CSP) in the lower uterine segment after cesarean section is a type of ectopic pregnancy that can cause major complications if left untreated. Transabdominal ultrasound is a common procedure but is influenced by external factors. Thus, intracavitary ultrasound may have better diagnostic efficiency for CSP.
AIM To assess the value of intracavitary ultrasound for diagnosing CSP in the lower uterine segment after cesarean section.
METHODS Patients diagnosed with CSP in our hospital from October 2019 to April 2021 were recruited. Transabdominal and intracavitary ultrasound examinations were performed to compare the diagnostic differences for CSP and its types.
RESULTS Sixty-three patients were diagnosed during the study period. The diagnostic accuracy for CSP was higher in intracavitary ultrasound (96.83%) than in transabdominal ultrasound (84.13%) (P < 0.05). The missed diagnosis and misdiagnosis rates did not differ among the ultrasound types (intra: 0.00% and 3.17%; trans: 4.76% and 11.11%, respectively; P > 0.05). For the diagnostic rates for the CSP types, the rates for gestational sac (100.00% vs 90.48%), heterogeneous mass (93.75% vs 75.00%), and part of the uterine cavity (80.00% vs 60.00%) were higher in intracavitary ultrasound than in transabdominal ultrasound, but the difference was not statistically significant (P > 0.05). For gestational sac CSP patients, intracavitary ultrasound showed that the gestational sac was located in the lower uterine segment scar with abundant peripheral blood flow; the distance between the gestational sac and the serosal layer was 2.42 ± 0.50 cm. Intracavitary ultrasound for heterogeneous mass CSP patients indicated that the mass mainly occurred in the lower anterior uterine wall, protruding into the bladder, and was surrounded by abundant internal and peripheral blood flow; the distance between the mass and serosal layer was 1.79 ± 0.30 cm. For CSP type partly located in the uterine cavity, the gestational sac was partly located in the lower uterine cavity and partly in the scar with abundant internal and peripheral blood flow; the distance between the gestational sac and the serosal layer was 2.29 ± 0.28 cm.
CONCLUSION Intracavitary ultrasound had a higher diagnostic accuracy and application value for diagnosing CSP than transabdominal ultrasound, with reduced risk of missed diagnoses and misdiagnosis, thereby preventing delayed treatment.
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Affiliation(s)
- Xiao-Ling Cheng
- Department of Ultrasonography, Women and Children Health Institute Futian Shenzhen, Shenzhen 518026, Guangdong Province, China
| | - Xiao-Yan Cao
- Department of Ultrasonography, Women and Children Health Institute Futian Shenzhen, Shenzhen 518026, Guangdong Province, China
| | - Xiao-Qian Wang
- Department of Ultrasonography, Women and Children Health Institute Futian Shenzhen, Shenzhen 518026, Guangdong Province, China
| | - Heng-Li Lin
- Department of Ultrasonography, Women and Children Health Institute Futian Shenzhen, Shenzhen 518026, Guangdong Province, China
| | - Jin-Chuan Fang
- Department of Ultrasonography, Women and Children Health Institute Futian Shenzhen, Shenzhen 518026, Guangdong Province, China
| | - Lin Wang
- Department of Ultrasonography, Women and Children Health Institute Futian Shenzhen, Shenzhen 518026, Guangdong Province, China
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14
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Savukyne E, Machtejeviene E, Paskauskas S, Ramoniene G, Nadisauskiene RJ. Transvaginal Sonographic Evaluation of Cesarean Section Scar Niche in Pregnancy: A Prospective Longitudinal Study. MEDICINA-LITHUANIA 2021; 57:medicina57101091. [PMID: 34684128 PMCID: PMC8540311 DOI: 10.3390/medicina57101091] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/06/2021] [Accepted: 10/09/2021] [Indexed: 12/02/2022]
Abstract
Background and Objectives: To investigate the prevalence of a Cesarean section (CS) scar niche during pregnancy, assessed by transvaginal ultrasound imaging, and to relate scar measurements, demographic and obstetric variables to the niche evolution and final pregnancy outcome. Materials and Methods: In this prospective observational study, we used transvaginal sonography to examine the uterine scars of 122 women at 11+0–13+6, 18+0–20+6 and 32+0–35+6 weeks of gestation. A scar was defined as visible on pregnant status when the area of hypoechogenic myometrial discontinuity of the lower uterine segment was identified. The CS scar niche (“defect”) was defined as an indentation at the site of the CS scar with a depth of at least 2 mm in the sagittal plane. We measured the hypoechogenic part of the CS niche in two dimensions, as myometrial thickness adjacent to the niche and the residual myometrial thickness (RMT). In the second and third trimesters of pregnancy, the full lower uterine segment (LUS) thickness and the myometrial layer thickness were measured at the thinnest part of the scar area. Two independent examiners measured CS scars in a non-selected subset of patients (n = 24). Descriptive analysis was used to assess scar visibility, and the intraclass correlation coefficient (ICC) was calculated to show the strength of absolute agreement between two examiners for scar measurements. Factors associated with the CS scar niche, including maternal age, BMI, smoking status, previous vaginal delivery, obstetrics complications and a history of previous uterine curettage, were investigated. Clinical information about pregnancy outcomes and complications was obtained from the hospital’s electronic medical database. Results: The scar was visible in 77.9% of the women. Among those with a visible CS scar, the incidence of a CS scar niche was 51.6%. The intra- and interobserver agreement for CS scar niche measurements was excellent (ICC 0.98 and 0.89, respectively). Comparing subgroups of women in terms of CS scar niche (n = 49) and non-niche (n = 73), there was no statistically significant correlation between maternal age (p = 0.486), BMI (p = 0.529), gestational diabetes (p = 1.000), smoking status (p = 0.662), previous vaginal delivery after CS (p = 1.000) and niche development. Uterine scar niches were seen in 56.3% (18/48) of the women who had undergone uterine curettage, compared with 34.4% (31/74) without uterine curettage (p = 0.045). We observed an absence of correlation between the uterine scar niche at the first trimester of pregnancy and mode of delivery (p = 0.337). Two cases (4.7%) of uterine scar dehiscence were confirmed following a trial of vaginal delivery. Conclusions: Based on ultrasonography examination, the CS scar niche remained visible in half of the cases with a visible CS scar at the first trimester of pregnancy and could be reproducibly measured by a transvaginal scan. Previous uterine curettage was associated with an increased risk for uterine niche formation in a subsequent pregnancy. Uterine scar dehiscence might be potentially related to the CS scar niche.
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Affiliation(s)
- Egle Savukyne
- Department of Obstetrics and Gynaecology, Hospital of Lithuanian University of Health Sciences, Kauno Klinikos, Eiveniu st. 2, 50161 Kaunas, Lithuania; (E.M.); (S.P.); (G.R.); (R.J.N.)
- Department of Obstetrics and Gynaecology, Medical Academy, Lithuanian University of Health Sciences, A.Mickevicius st. 7, 44307 Kaunas, Lithuania
- Correspondence: ; Tel.: +370-685-155-84
| | - Egle Machtejeviene
- Department of Obstetrics and Gynaecology, Hospital of Lithuanian University of Health Sciences, Kauno Klinikos, Eiveniu st. 2, 50161 Kaunas, Lithuania; (E.M.); (S.P.); (G.R.); (R.J.N.)
- Department of Obstetrics and Gynaecology, Medical Academy, Lithuanian University of Health Sciences, A.Mickevicius st. 7, 44307 Kaunas, Lithuania
| | - Saulius Paskauskas
- Department of Obstetrics and Gynaecology, Hospital of Lithuanian University of Health Sciences, Kauno Klinikos, Eiveniu st. 2, 50161 Kaunas, Lithuania; (E.M.); (S.P.); (G.R.); (R.J.N.)
- Department of Obstetrics and Gynaecology, Medical Academy, Lithuanian University of Health Sciences, A.Mickevicius st. 7, 44307 Kaunas, Lithuania
| | - Gitana Ramoniene
- Department of Obstetrics and Gynaecology, Hospital of Lithuanian University of Health Sciences, Kauno Klinikos, Eiveniu st. 2, 50161 Kaunas, Lithuania; (E.M.); (S.P.); (G.R.); (R.J.N.)
- Department of Obstetrics and Gynaecology, Medical Academy, Lithuanian University of Health Sciences, A.Mickevicius st. 7, 44307 Kaunas, Lithuania
| | - Ruta Jolanta Nadisauskiene
- Department of Obstetrics and Gynaecology, Hospital of Lithuanian University of Health Sciences, Kauno Klinikos, Eiveniu st. 2, 50161 Kaunas, Lithuania; (E.M.); (S.P.); (G.R.); (R.J.N.)
- Department of Obstetrics and Gynaecology, Medical Academy, Lithuanian University of Health Sciences, A.Mickevicius st. 7, 44307 Kaunas, Lithuania
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15
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Agarwal N, Gainder S, Chopra S, Rohilla M, Prasad G, Jain V. The Management of Scar Ectopic: A Single-Center Experience. Cureus 2021; 13:e15881. [PMID: 34336408 PMCID: PMC8312794 DOI: 10.7759/cureus.15881] [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] [Accepted: 06/23/2021] [Indexed: 11/05/2022] Open
Abstract
PURPOSE This study aimed to highlight the clinical features, diagnosis, and different modalities of the treatment of cesarean scar pregnancy (CSP). METHODS This study was done in the tertiary referral hospital of India for one year. A total of 11 cases were enrolled prospectively. In each case, the diagnostic ultrasonography and measurement of baseline beta-human chorionic gonadotropin (β-HCG) levels were done. The treatment was given based on the hemodynamic status of the patient and desire for future fertility. Various treatment modalities used were medical, surgical, or interventional digital subtraction angiography to control hemorrhage. Also, in some cases, ultrasound-guided methotrexate was injected into the scar ectopic. Medically treated cases were followed up until their β-HCG levels became normal. RESULTS Out of 11 patients, six had a history of two cesarean sections in the past, four patients had a history of one cesarean section and one patient with a previous three low segments cesarean section (LSCS). Seven out of 11 patients underwent medical management with either methotrexate with potassium chloride (KCl) or methotrexate alone. The success of the medical management was monitored by serial β- HCG values. The mean time for the resolution of these 10 patients was 86.7 ± 53.6 days. Three patients underwent emergency uterine artery embolization due to uncontrolled bleeding and one patient required laparotomy. CONCLUSION CSP is a life-threatening condition that can be diagnosed with the help of transvaginal ultrasonography. The treatment, however, depends on the hemodynamic status of the patient and desire for future fertility. Well-defined diagnostic criteria coupled with structured management and follow-up protocol can help in treating this challenging form of ectopic pregnancy.
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Affiliation(s)
- Neha Agarwal
- Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, IND.,Obstetrics and Gynecology, Maulana Azad Medical College, New Delhi, IND
| | - Shalini Gainder
- Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
| | - Seema Chopra
- Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
| | - Minakshi Rohilla
- Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
| | - Grv Prasad
- Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
| | - Vanita Jain
- Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
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16
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Gull B, Klerelid V, Jormeus A, Strandell A. Potential risk factors for caesarean scar pregnancy: a retrospective case-control study. Hum Reprod Open 2021; 2021:hoab019. [PMID: 33959686 PMCID: PMC8087894 DOI: 10.1093/hropen/hoab019] [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: 02/11/2021] [Revised: 03/22/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What are the important risk factors for having a caesarean scar pregnancy (CSP)? SUMMARY ANSWER Independent risk factors were smoking in the first trimester, higher parity, and previous caesarean section (CS) before the index caesarean delivery. WHAT IS KNOWN ALREADY A spectrum of risk factors for CSP has been suggested but not proven: parity, number of previous caesarean section, elective as opposed to emergency CS, IVF-pregnancy, breech presentation, previous gynaecological surgery as well as suture technique. STUDY DESIGN SIZE DURATION This retrospective case-control study included 31 women with a CSP during the period 2003-2018 treated at a tertiary care centre for gynaecology and reproduction. A control cohort of 8300 women with a history of a CS and a subsequent delivery during the same time period was formed. PARTICIPANTS/MATERIALS SETTING METHODS Variables describing demography, lifestyle factors, and reproductive and obstetric history were retrieved from medical records and the obstetric hospital database. Logistic regression analyses were applied to identify potential risk factors. MAIN RESULTS AND THE ROLE OF CHANCE In a multivariable analysis, smoking in first trimester (adjusted odds ratio (OR) 3.03, 95% CI 1.01-9.07), higher parity (adjusted OR 1.30, 95% CI 1.03-1.64) and previous CS in addition to the preceding CS (adjusted OR 3.43, 95% CI 1.35-8.66) were independently predictive of a CSP. An elective CS at the index pregnancy was associated with an increased risk of CSP but did not remain significant in the multivariable analysis. LIMITATIONS REASONS FOR CAUTION CSP is a very rare phenomenon and several of the risk factor estimates are imprecise. Nevertheless, significant risk factors could be identified. Another limitation is the lack of electronically recorded details on suture techniques. WIDER IMPLICATIONS OF THE FINDINGS The identified factors, namely higher parity and previous CS before the index caesarean section, are in accordance with previously suggested risk factors. Whether there is a true risk association between elective CS and future CSP needs to be investigated further. Smoking in the first trimester is a new finding, which has a plausible rationale. These factors should be recognised when counselling women after a caesarean delivery, particularly in a subsequent pregnancy with early complications. STUDY FUNDING/COMPETING INTERESTS This work was supported by a grant from the Swedish state under the agreement between the Swedish government and the county councils the ALF-agreement (ALFGBG-720291). None of the authors has any conflict of interest to declare.
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Affiliation(s)
- B Gull
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden
| | - V Klerelid
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden
| | - A Jormeus
- Department of Gynecology, Närhälsan Kungshöjd, Gothenburg, Region Västra Götaland, Sweden
| | - A Strandell
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden.,Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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17
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Kumari V, Kumar H, Datta MR. The Importance of Ectopic Mindedness: Scar Ectopic Pregnancy, a Diagnostic Dilemma. Cureus 2021; 13:e13089. [PMID: 33728112 PMCID: PMC7933601 DOI: 10.7759/cureus.13089] [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] [Indexed: 11/05/2022] Open
Abstract
There has been a consistent rise in ectopic pregnancies due to increase in maternal age, infertility treatment, cesarean sections, smoking among women, and use of contraceptives. With the extratubal ectopic pregnancies accounting for only 4% of the total ectopic pregnancies, scar pregnancies are even more of a rare entity with their incidence being less than 1%. We hereby present two cases of ectopic pregnancies, which though managed successfully presented a huge diagnostic challenge in the first case while the diagnosis was completely missed in the second case, hence, emphasizing the need for ectopic mindedness when dealing with early pregnancies.
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Affiliation(s)
- Vina Kumari
- Obstetrics and Gynaecology, Tata Main Hospital, Jamshedpur, IND
| | | | - Mamta R Datta
- Obstetrics and Gynaecology, Tata Main Hospital, Jamshedpur, IND
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18
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Erem AS, Konney TO, Appiah-Kubi A, Ankomah K, Amankwa AT, Annan JJK, Tawiah A, Amoako-Adjei BK, Lartey KF, Lawrence ER. Use of Magnetic Resonance Imaging (MRI) in the Management of Diagnostic Uncertainty in Low-Resource Settings: A Case Report of Cesarean Ectopic Pregnancy in a Tertiary Hospital in Ghana. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e927496. [PMID: 33370250 PMCID: PMC7774991 DOI: 10.12659/ajcr.927496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patient: Female, 35-year-old Final Diagnosis: Cesarean section ectopic pregnancy Symptoms: Amenorrhea Medication:— Clinical Procedure: Exploratory laparotomy • MRI • ultrasonography Specialty: Obstetrics and Gynecology
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Affiliation(s)
- Anna Sarah Erem
- Department of Obstetrics and Gynecology, Saba University School of Medicine, Saba, Netherlands Antilles
| | - Thomas Okpoti Konney
- Department of Obstetrics and Gynecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Adu Appiah-Kubi
- Department of Obstetrics and Gynecology, University of Health and Allied Sciences, Ho, Ghana
| | - Kwasi Ankomah
- Department of Radiology, Komfo Anokye Teaching Hospital, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Adu Tutu Amankwa
- Department of Radiology, Komfo Anokye Teaching Hospital, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - John Jude Kweku Annan
- Department of Obstetrics and Gynecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Augustine Tawiah
- Department of Obstetrics and Gynecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Kwabena Fosu Lartey
- Department of Anesthesiology, Komfo Anokye Teaching Hospital, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emma R Lawrence
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
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19
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Wang L, Lv S, Mao W, Bai E, Yang X. Fecundity disorders in older women: declines in follicular development and endometrial receptivity. BMC WOMENS HEALTH 2020; 20:115. [PMID: 32487204 PMCID: PMC7268486 DOI: 10.1186/s12905-020-00979-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/24/2020] [Indexed: 02/07/2023]
Abstract
Background Little research is available on follicular development and endometrial receptivity in older women. This study aimed to assess follicular development and endometrial receptivity, and to evaluate ultrasonic parameters in predicting endometrial receptivity during the implantation window in older women. Methods For this prospective case-control study, 224 older women and 215 young women were recruited. The follicular development and endometrial thickness were monitored by transvaginal ultrasound. During the implantation window, the pulsatility index (PI) and resistance index (RI) of the uterine arteries and subendometrial region, endometrial volume, vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated between the two groups. The ultrasonic parameters were used to assess endometrial receptivity in older women. Results The serum anti-Mullerian hormone (AMH) concentration and antral follicle count (AFC) were significantly lower in older women than in young women. The average diameter of the dominant follicle on days 14, 16, and 18 of the menstrual cycle were significantly smaller, and the subendometrial region RI on days 12, 14, 16, and 18 of the menstrual cycle were significantly higher in older women than in young women. The normal ovulation rate was significantly lower in older women than in young women. The subendometrial region RI was significantly higher, and the endometrial VI, FI, and VFI were significantly lower in older women compared with young women. The biochemical pregnancy rate, clinical pregnancy rate and ongoing pregnancy rate of older women were significantly lower than in young women. The best ultrasonic parameter for predicting endometrial receptivity during the implantation window in older women was VI (AUC =0.889, sensitivity 92.6% and specificity 85.4%). Conclusions Older women present decreased serum AMH concentrations and AFC, defined as indicators of ovarian reserve function. Older women are characterized by decreased follicular development and endometrial receptivity, which may lead to fecundity disorders.
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Affiliation(s)
- Li Wang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shulan Lv
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Wenjun Mao
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - E Bai
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaofeng Yang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
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