CESAREAN SCAR ECTOPIC PREGNANCY: SURGICAL TREATMENT

  • Vanja Dimitrov Univerzitet u Nišu, Medicinski fakultet
  • Milan Stefanović University of Niš, Faculty of Medicine, Gynecology with Obstetrics, Niš, Serbia; University Clinical Center Niš, Clinic for Gynecology and Obstetrics, Niš, Serbia
  • Vladimir Cvetanović University of Niš, Faculty of Medicine, Gynecology with Obstetrics, Niš, Serbia; University Clinical Center Niš, Clinic for Gynecology and Obstetrics, Niš, Serbia
  • Gorana Nedin Ranković University of Niš, Faculty of Medicine, Gynecology with Obstetrics, Niš, Serbia; University Clinical Center Niš, Clinic for Gynecology and Obstetrics, Niš, Serbia
  • Sonja Pop-Trajković University of Niš, Faculty of Medicine, Gynecology with Obstetrics, Niš, Serbia; University Clinical Center Niš, Clinic for Gynecology and Obstetrics, Niš, Serbia
  • Milan Trenkić University of Niš, Faculty of Medicine, Gynecology with Obstetrics, Niš, Serbia; University Clinical Center Niš, Clinic for Gynecology and Obstetrics, Niš, Serbia
Keywords: ectopic pregnancy, cesarean scar, suction curettage

Abstract


Cesarean scar ectopic pregnancy is one of the rarest forms of ectopic pregnancy. It occurs in approximately 1 out of 2000 pregnancies. There are many challenges in its diagnosis and management which if not recognised can endanger the patient and provide poor outcomes, with a high rate of maternal morbidity or mortality. In cesarean scar ectopic pregnancies an embryo attaches to the scar tissue from the previous cesarean section and grows in the uterine wall that is not strong, so it may cause life-threatening hemorrhage, leading to a hysterectomy and potential devastating consequences. This is a case report of a 35-year-old pregnant woman, with cesarean scar ectopic pregnancy, who has one cesarean section in her medical history and was treated by ultrasound-guided suction curettage.

References

Ash A, Smith A, Maxwell D. Caesarean scar pregnancy. BJOG 2007; 114(3):253-63. [CrossRef] [PubMed]

Chang Y, Kay N, Chen YH, Chen HS, Tsai EM. Resectoscopic treatment of ectopic pregnancy in previous cesarean delivery scar defect with vasopressin injection. Fertil Steril 2011; 96(2):e80-2. [CrossRef] [PubMed]

Cheng PJ, Chueh HY, Soong YK. Sonographic diagnosis of a uterine defect in a pregnancy at 6 weeks' gestation with a history of curettage. Ultrasound Obstet Gynecol 2003; 21(5):501-3. [CrossRef] [PubMed]

Creanga AA, Shapiro-Mendoza CK, Bish CL, Zane S, Berg CJ, Callaghan WM. Trends in ectopic pregnancy mortality in the United States: 1980-2007. Obstet Gynecol 2011; 117(4):837-43. [CrossRef] [PubMed]

Cunningham F, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, Spong CY, editors. Williams Obstetrics, 25e. New York: McGraw-Hill Education; 2018. p. 80-123.

Demirel LC, Bodur H, Selam B, Lembet A, Ergin T. Laparoscopic management of heterotopic cesarean scar pregnancy with preservation of intrauterine gestation and delivery at term: case report. Fertil Steril 2009;91(4):1293.e5-7. [CrossRef] [PubMed]

Diagnosis and management of ectopic pregnancy: Green-top guideline No. 21. BJOG 2016; 123(13):e15-e55. [CrossRef] [PubMed]

Fuchs N, Manoucheri E, Verbaan M, Einarsson JI. Laparoscopic management of extrauterine pregnancy in caesarean section scar: description of a surgical technique and review of the literature. BJOG 2015; 122(1):137-40. [CrossRef] [PubMed]

Fylstra DL. Ectopic pregnancy within a cesarean scar: a review. Obstet Gynecol Surv 2002; 57(8):537-43. [CrossRef] [PubMed]

Jameel K, Abdul Mannan GE, Niaz R, Hayat DE. Cesarean scar ectopic pregnancy: a diagnostic and management challenge. Cureus 2021; 13(4):e14463. [CrossRef] [PubMed]

Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson CJ. First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment Cesarean section scar. Ultrasound Obstet Gynecol 2003; 21(3):220-7. [CrossRef] [PubMed]

Jurkovic D, Knez J, Appiah A, Farahani L, Mavrelos D, Ross JA. Surgical treatment of Cesarean scar ectopic pregnancy: efficacy and safety of ultrasound-guided suction curettage. Ultrasound Obstet Gynecol 2016; 47(4):511-7. [CrossRef] [PubMed]

Maymon R, Halperin R, Mendlovic S, Schneider D, Herman A. Ectopic pregnancies in a Caesarean scar: review of the medical approach to an iatrogenic complication. Hum Reprod Update 2004; 10(6):515-23. [CrossRef] [PubMed]

Robinson JK, Dayal MB, Gindoff P, Frankfurter D. A novel surgical treatment for cesarean scar pregnancy: laparoscopically assisted operative hysteroscopy. Fertil Steril 2009;92(4):1497.e13-16. [CrossRef] [PubMed]

Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol 2006; 107(6):1373-81. [CrossRef] [PubMed]

Seow KM, Huang LW, Lin YH, Lin MY, Tsai YL, Hwang JL. Cesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol 2004; 23(3):247-53. [CrossRef] [PubMed]

Vial Y, Petignat P, Hohlfeld P. Pregnancy in a cesarean scar. Ultrasound Obstet Gynecol 2000; 16(6):592-3. [CrossRef] [PubMed]

Wang G, Liu X, Bi F, Lili Yin MM, Rina Sa MM, Dandan Wang MM et al. Evaluation of the efficacy of laparoscopic resection for the management of exogenous cesarean scar pregnancy. Fertil Steril 2014; 101(5):1501-7. [CrossRef] [PubMed]

Xiao Z, Cheng D, Chen J, Yang J, Xu W, Xie Q. The effects of methotrexate and uterine arterial embolization in patients with cesarean scar pregnancy: A retrospective case-control study. Medicine (Baltimore) 2019; 98(11):e14913. [CrossRef] [PubMed]

Yang Q, Piao S, Wang G, Wang Y, Liu C. Hysteroscopic surgery of ectopic pregnancy in the cesarean section scar. J Minim Invasive Gynecol 2009; 16(4):432-6. [CrossRef] [PubMed]

Published
2025/02/07
Section
Case report