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Shoai BB, Gibbs L, Leonis R. Cesarean Scar Pregnancy With Surgical and Conservative Managements: A Case Report. Cureus 2024; 16:e61311. [PMID: 38947697 PMCID: PMC11212840 DOI: 10.7759/cureus.61311] [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] [Accepted: 05/28/2024] [Indexed: 07/02/2024] Open
Abstract
A cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy. Proper diagnosis and management of CSP are incredibly important secondary to the risk of uterine rupture and life-threatening hemorrhage. Various medical and surgical management have been described previously. This report looks at two cases of CSP diagnosed at an urban hospital in Atlanta, Georgia. The first woman was 30 years old with a history of five prior CS. She was referred from an abortion clinic for CSP at 6 weeks 2 days gestation. She did not desire future fertility and opted for a hysterectomy. The second woman was 38 years old with a history of three prior CS presenting with vaginal bleeding and abdominal pain and found to have a CSP with a gestation sac measuring 5 weeks 1 day. Given the patient's desires for future fertility, she was treated with a two-dose regimen of systemic intramuscular methotrexate (MTX) at 1 mg/kg with successful resolution of CSP and subsequent intrauterine pregnancy. Due to the high risk of uterine rupture and hemorrhage with CSP, it is important to have a high index of suspicion for diagnosis. Due to the rarity of CSP, and thus difficulty creating quality prospective trials, there is no consensus on the best management yet. Although conservative treatment carries high failure risk, shared decision-making incorporating future fertility desires should be considered when determining management of CSP, and when surgical management is considered a minimally invasive approach should be the standard of care in surgical management.
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Affiliation(s)
- Banafsheh B Shoai
- Obstetrics and Gynecology, Morehouse School of Medicine, Atlanta, USA
| | - Lauren Gibbs
- Obstetrics and Gynecology, Morehouse School of Medicine, Atlanta, USA
| | - Regina Leonis
- Obstetrics and Gynecology, Morehouse School of Medicine, Atlanta, USA
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Kłobuszewski B, Szmygin M, Nieoczym K, Kłobuszewska O, Woźniak S, Pyra KK. Advances in Treating Cesarean Scar Pregnancy: A Comprehensive Review of Techniques, Clinical Outcomes, and Fertility Preservation. Med Sci Monit 2024; 30:e943550. [PMID: 38566372 PMCID: PMC11000526 DOI: 10.12659/msm.943550] [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] [Received: 12/19/2023] [Accepted: 02/01/2024] [Indexed: 04/04/2024] Open
Abstract
Cesarean scar pregnancy (CSP) is a rare but potentially dangerous condition that occurs when an embryo implants and develops within the scar tissue from a previous cesarean section. Treatment of cesarean scar pregnancy depends on several factors, including the gestational age of the pregnancy, the presence of complications, and the individual patient's circumstances. We performed a systematic review of the published literature on management of cesarean scar pregnancy and the outcomes, complications, and effects on fertility. A systematic review of recent scientific literature published up to April 2023 in the databases PubMed, Google Scholar, and Web of Science was performed according to the PRISMA guidelines. We used the search keywords "cesarean scar pregnancy," "methotrexate," "systemic," "chemoembolization," and "uterine artery embolization." The baseline search resulted in 413 articles. After the exclusion of 342 irrelevant articles, the abstracts and titles of the remaining 71 articles were read for potential inclusion, resulting in exclusion of a further 16 articles. Therefore, the full texts of 55 articles were investigated. Finally, 42 papers were included in the study. The main finding was that chemoembolization is more successful than systemic methotrexate therapy, and is associated with less blood loss and shorter hospital stay. Transarterial chemoembolization appears to be safe and effective method of treatment in patients with CSP and should thus be considered during multidisciplinary evaluation of these patients.
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Affiliation(s)
- Bartosz Kłobuszewski
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Maciej Szmygin
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
- Department of Human Anatomy, Medical University of Lublin, Lublin, Poland
| | - Karolina Nieoczym
- Student Scientific Society at the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Olga Kłobuszewska
- Department of Pediatric Radiology, University Pediatric Hospital, Lublin, Poland
| | - Sławomir Woźniak
- Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Konrad Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
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Zikopoulos A, Loukopoulos T, Galani A, Kechagias K, Skentou C, Zikopoulos K, Kolibianakis E. Methotrexate treatment of very high β-HCG ectopic pregnancy on previous cesarean scar: A case report. Radiol Case Rep 2023; 18:4106-4109. [PMID: 37720917 PMCID: PMC10504459 DOI: 10.1016/j.radcr.2023.08.051] [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: 06/01/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 09/19/2023] Open
Abstract
Ectopic pregnancy in a previous caesarean scar is a rare, potentially life-threatening situation that can cause massive bleeding and uterine rupture. Clinical symptoms can range from vaginal bleeding with or without pain, to uterine rupture with hypovolemic shock. Early diagnosis is possible by ultrasound examination, and it is very important because it leads to prompt management, improving maternal morbidity and mortality as well as future fertility. The current case report refers to a G3P2 woman with a history of 2 previous caesarean deliveries, who was diagnosed with an ectopic pregnancy on the caesarean scar using ultrasonography. The patient was treated with methotrexate both systemic and into the sac, as well as with injection into the sac of 5mEq potassium chloride. The woman was followed up until measurements of serum β-Human Chorionic Gonadotropin were within nonpregnant levels. There is no clear-cut best way to handle cesarean scar pregnancy. Pregnancy with a cesarean scar should be identified and treated as soon as possible in order to avoid serious problems and preserve fertility. However, even more advanced cesarean scar pregnancies can be managed conservatively at first, when a highly expertized team in a tertiary hospital is available.
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Affiliation(s)
| | | | - Apostolia Galani
- Department of Obstetrics and Gynecology, University Hospital of Ioannina, Ioannina, Greece
| | - Konstantinos Kechagias
- Department of Obstetrics and Gynecology, University Hospital of Ioannina, Ioannina, Greece
| | - Charikleia Skentou
- Department of Obstetrics and Gynecology, University Hospital of Ioannina, Ioannina, Greece
| | | | - Efstratios Kolibianakis
- Unit for Human Reproduction, 1st Dept of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Elawad M, Alyousef SZH, Alkhaldi NK, Alamri FA, Bakhsh H. Scar Ectopic Pregnancy as an Uncommon Site of Ectopic Pregnancy: A Case Report and Literature Review. Life (Basel) 2023; 13:2151. [PMID: 38004291 PMCID: PMC10672687 DOI: 10.3390/life13112151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/03/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
A cesarean scar pregnancy is a rare type of ectopic pregnancy that occurs when a fertilized egg implants in the scar from a previous cesarean section. It is a serious condition that can lead to significant morbidity and mortality if not managed promptly and appropriately. In this literature review and case report, we discuss the etiology, diagnosis, and management of cesarean scar pregnancy. We conducted a comprehensive search of relevant literature using electronic databases and included studies that reported on the diagnosis and management of cesarean scar pregnancy. We also present a case report of a patient with cesarean scar pregnancy who was managed surgically. The diagnosis of cesarean scar pregnancy is primarily done via transvaginal or transabdominal ultrasound, and medical or surgical management can be used depending on the gestational age, hemodynamic status, and patient preferences. The surgical approach, which involves hysteroscopy, laparoscopy, or laparotomy, is usually preferred, since it is associated with fast recovery and lower recurrence rates. However, it is crucial to consider the patient's plans for future fertility when selecting the management approach. In conclusion, cesarean scar pregnancy is a rare but potentially life-threatening condition that requires prompt and appropriate management. Early diagnosis and treatment can prevent significant morbidity and mortality, and surgical management is usually preferred due to its higher success rates and lower recurrence rates.
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Affiliation(s)
- Mamoun Elawad
- Obstetrics & Gynecology Department, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia;
| | | | - Njoud Khaled Alkhaldi
- Clinical Sciences Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia; (N.K.A.); (F.A.A.)
| | - Fayza Ahmed Alamri
- Clinical Sciences Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia; (N.K.A.); (F.A.A.)
| | - Hanadi Bakhsh
- Clinical Sciences Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia; (N.K.A.); (F.A.A.)
- Department of Obstetrics and Gynecology, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia
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Fernandez CM, Levine EM, Shashoua A, Sodini I, Duval J, Juna J. Recognition of the Type of Cesarean Scar Pregnancy in First Trimester Sonography. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2022. [DOI: 10.1177/87564793221112354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This case series is presented to illustrate the clinical value of identifying, sonographically, the type of cesarean scar ectopic pregnancy that may present, as this has become more frequently encountered. The choice of surgical treatment appears to be dependent on the sonographic typing, of this specific type of ectopic pregnancy. This case study illustrates the importance of this topic, given the rising incidence of cesarean deliveries coupled with the increase in first trimester sonograms being more commonly performed. The value of proper diagnostic detection is important, given the contemporary management of this new type of ectopic pregnancy.
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Affiliation(s)
| | - Elliot M. Levine
- Advocate Illinois Masonic Medical Center, Chicago, IL, USA
- University of Illinois at Chicago, Chicago, IL, USA
| | | | - Irma Sodini
- Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | - Jude Duval
- Advocate Illinois Masonic Medical Center, Chicago, IL, USA
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