A Cesarean scar pregnancy is not an ectopic pregnancy

Timor‐Tritsch, I. E.

doi:10.1002/uog.24877

Cited by 12 publications

(5 citation statements)

References 15 publications

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“…CSP has received considerable attention because of its increasing incidence, as well as its life-threatening risks [ 19 , 20 ]. Type II CSP warrants more attention because of a greater risk of catastrophic complications [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Complex Blood Supply Patterns in Cesarean Scar Pregnancy: Insights from Digital Subtraction Angiography Imaging

Gao

Guo

et al. 2023

Med Sci Monit

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Background Understanding the blood supply pattern of cesarean scar pregnancy (CSP) can effectively help to determine the best choice of treatment. The aim of this study was to investigate the blood supply pattern and outcomes of patients with CSP through digital subtraction angiography (DSA) imaging. Material/Methods This was a retrospective cohort study. Patients were divided into 2 groups according to the type of CSP. The DSA images of these patients were reviewed, including the type of blood supply, dominant vessel, and collateral blood supply to the gestational sac. The clinical outcomes were analyzed between the 2 groups. Results Thirty-seven patients with type I and 29 patients with type II CSP were enrolled in this study. Type II CSP showed a higher proportion of rich blood supply than type I (44.83% vs 29.72%, P >0.05). Compared with type II CSP, type I CSP tended to have bilateral dominant blood supply predominance (67.57% vs 41.38%, P <0.05). The incidence of collateral blood supply was 5.41% in the type I CSP group and 31.03% in the type II CSP group ( P <0.05). In the type II CSP group, multiple collateral blood vessels were found in 4 patients. The superior vesicle artery was the most common source of collateral blood supply in both groups. Two patients with type II CSP suffered massive bleeding during surgery after uterine artery embolization (UAE). None of the patients received a hysterectomy. Conclusions UAE is safe and effective for both types of CSP. The blood supply pattern is more complex and abnormal in type II CSP. More attention should be paid to the collateral blood supply to achieve complete embolization during the UAE procedure in the case of type II CSP.

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Section: Discussionmentioning

confidence: 99%

Complex Blood Supply Patterns in Cesarean Scar Pregnancy: Insights from Digital Subtraction Angiography Imaging

Gao

Guo

et al. 2023

Med Sci Monit

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“…11 Furthermore, there has been recent debate among experts on whether CSP should be distinguished from other EP given its potential to be managed expectantly to result in live births. 13,14 Overall, much work still lies ahead to achieve a complete international consensus in the terminology and classification of these rarer EP types, which is essential to lay the foundations of further research and international collaboration in the development of an evidenced-based practice for the management of NTEP.…”

Section: Discussionmentioning

confidence: 99%

“…11,12 However, the European Society of Human Reproduction and Embryology (ESHRE) has recently proposed a shift away from the traditional classification of tubal and non‐tubal EP, and adopted the terms uterine and extra‐uterine instead, which are clearer in the delineation of the EP sites and can facilitate optimal management planning 11 . Furthermore, there has been recent debate among experts on whether CSP should be distinguished from other EP given its potential to be managed expectantly to result in live births 13,14 . Overall, much work still lies ahead to achieve a complete international consensus in the terminology and classification of these rarer EP types, which is essential to lay the foundations of further research and international collaboration in the development of an evidenced‐based practice for the management of NTEP.…”

Section: Discussionmentioning

confidence: 99%

A 10‐year retrospective cohort study of non‐tubal ectopic pregnancy management outcomes in an Australian tertiary centre

Loh

Adno

Reid

2022

Australas J Ultrason Med

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Introduction Non‐tubal ectopic pregnancy (NTEP) is a rare but significant early pregnancy complication which can result in maternal morbidity and mortality. There is however a lack of evidence‐based guidelines for the management of NTEP. Purpose To evaluate the success rates of expectant, medical and surgical management in the treatment of NTEP at our tertiary centre. Methods Retrospective cohort study from 2010 to 2020. All NTEP were classified by ectopic sites. Primary management was classified by expectant, medical [systemic methotrexate (Sys‐MTX) and/or local ultrasound‐guided injection of MTX and/or KCl intra‐sac (L‐MTX, L‐MTX/KCl)] or surgical. Primary management was considered successful if no change in intervention was required. Treatment complications were compared. Results Twenty‐four NTEP were identified, which included 14 interstitial pregnancies (IP), 9 caesarean scar pregnancies (CSP) and 1 ovarian pregnancy (OP), which gave NTEP an incidence of 7.12% among all EP (4.15% for IP, 2.67% for CSP and 0.30% for OP). The success of primary surgical management was 100% (7/7), primary medical management was 76.9% (10/13) and primary expectant management was 33.3% (1/3). Primary medical management had a non‐statistically significant greater mean time to serum ß‐human Chorionic Gonadotrophin <5 IU/L, mean length of hospitalisation, mean number of follow‐up visits and hospital re‐presentation/readmissions compared to primary surgical management. There was no other difference in complication rates between the treatment management groups. Conclusion Surgery remains the most effective way to manage NTEP. However, medical management can be a safe and effective alternative option in carefully selected cases.

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“…We very much appreciate the continued interest expressed by Jurkovic et al . concerning our Opinion piece, ‘A Cesarean scar pregnancy is not an ectopic pregnancy’ 1 . Such discussion allows for further academic exploration and evolution of concepts – all, hopefully, for the betterment of care of our patients.…”

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confidence: 96%

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Timor‐Tritsch

Goldstein

2022

Ultrasound in Obstet & Gyne

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A Cesarean scar pregnancy is not an ectopic pregnancy

Abstract: Linked article: There is a comment on this article by Jurkovic et al. Click https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/uog.24921 to view the Correspondence.

Cited by 12 publications

References 15 publications

Complex Blood Supply Patterns in Cesarean Scar Pregnancy: Insights from Digital Subtraction Angiography Imaging

Complex Blood Supply Patterns in Cesarean Scar Pregnancy: Insights from Digital Subtraction Angiography Imaging

A 10‐year retrospective cohort study of non‐tubal ectopic pregnancy management outcomes in an Australian tertiary centre

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