Study of various treatment modalities of caesarean scar pregnancy

Authors

  • Prachi C. Meghani Department of Obstetrics and Gynecology, NHL Municipal Medical College, Ahmedabad, Gujarat, India
  • Sapna R. Shah Department of Obstetrics and Gynecology, NHL Municipal Medical College, Ahmedabad, Gujarat, India
  • Rupa C. Vyas Department of Obstetrics and Gynecology, NHL Municipal Medical College, Ahmedabad, Gujarat, India
  • Purvi M. Parikh Department of Obstetrics and Gynecology, NHL Municipal Medical College, Ahmedabad, Gujarat, India
  • Tanmay J. Chudasama Department of Obstetrics and Gynecology, NHL Municipal Medical College, Ahmedabad, Gujarat, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20215107

Keywords:

CSP, Placenta accreta spectrum, Color doppler

Abstract

Background: Caesarean scar pregnancy (CSP) can be defined as the implantation of the gestational sac within the scar of a previous caesarean surgery. Incidence of CSP is 1 in 1800 pregnancies.

Methods: It is a retrospective study based on clinical diagnosis and management of CSP of women who presented to the obstetrics and gynaecology department SVP hospital from January 2008 to August 2021. Total number of cases of CSP were 28. Incidence, gestational age, ultrasound findings, serum β-human chorionic gonadotropin (β-hCG) levels, flow profiles of color Doppler, and different methods of treatment were recorded. Diagnosis was confirmed by ultrasound.

Results: In this study, all 28 cases of CSP considered were offered definitive management. In present study 5 cases (17.88%) showed torrential haemorrhage during dilatation and evacuation (D and E) which was treated by various methods like 1 (3.57%) Foley’s tamponade, 1 (3.57%) uterine artery embolization (UAE) and 3 (10.71%) hysterectomy. Hysterotomy was performed in 13 cases (46.42%) and (7.69%) of heterotrophic CSP (HCSP). One case (3.84%) of CSP presented at 26 weeks of gestation with haemorrhagic shock, underwent obstetric hysterectomy.

Conclusions: There is a rise in the incidence of CSP because of increase in the global rate of caesarean sections and early transvaginal USG in pregnancy. Transvaginal sonography is the best diagnostic tool. Medical management can be offered when diagnosis is made at gestational age of <7 weeks. Whereas, surgical modalities have shown better results at >7 weeks of gestational age. Surgical management has an advantage of shorter follow up.

 

References

Rotas M, Haberman S, Levgur M. Cesarean scar ectopic pregnancies: aetiology, diagnosis, and management. Obstet Gynecol. 2006;107(6):1373-81.

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

El Gelany S, Mosbeh MH, Ibrahim EM. Placenta Accreta Spectrum (PAS) disorders: incidence, risk factors and outcomes of different management strategies in a tertiary referral hospital in Minia, Egypt: a prospective study. BMC Pregnancy Childbirth. 2019;19(1):313.

Seow KM, Huang LW, Lin YH. Cesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol. 2004;23(3):247-53.

Bodour S. The efficacy of the systemic methotrexate treatment in caesarean scar ectopic pregnancy: A quantitative review of English literature. J Obstet Gynaecol. 2015;35(3):290-6.

Bij de Vaate AJ, Huirne JA, Van der Slikke JH. Medical treatment of cesarean scar pregnancy. J Minim Invasive Gynecol. 2010;17:133.

Lian F, Wang Y, Chen W. Uterine artery embolization combined with local methotrexate and systemic methotrexate for treatment of cesarean scar pregnancy with different ultrasonographic pattern Cardiovasc Intervent Radiol. 2012;35:286-91.

Wang CB, Tseng CJ. Primary evacuation therapy for Cesarean scar pregnancy. Ultrasound Obstet Gynecol. 2006;27(2):222-6.

Wang HY, Zhang J, Li YN. Laparoscopic management or laparoscopy combined with transvaginal management of type II cesarean scar pregnancy. JSLS. 2013;17(2):263-72.

Jurkovic D, Ben-Nagi J, Ofilli-Yebovi D. Efficacy of Shirodkar cervical suture in securing haemostasis following surgical evacuation of Cesarean scar ectopic pregnancy. Ultrasound Obstet Gynecol. 2007;30(1):95-100.

Timor-Tritsch IE, Monteagudo A, Cali G. Cesarean scar pregnancy is a precursor of morbidly adherent placenta. Ultrasound Obstet Gynecol. 2014;44(3):346-53.

Downloads

Published

2021-12-28

Issue

Section

Original Research Articles