Ceasarean scar pregnancies, diagnosis and management

Abstract

INTRODUCTIONCSP is an iatrogenic complication of a previous ceasarean delivery. The true incidence of CSP is unknown. Incidence of CSP is currently estimated at 1:1800-2200 pregnancies.1,2 With a history of a previous cesarean delivery, it is estimated that 0.15% of all pregnancies will be followed by a CSP in the woman's next pregnancy. 3Although rare , the possibility of a recurrent CSP is also possible and greater awareness on part of the clinician and the patient is essential .Unfortunately, CSPs are often misdiagnosed as abortions in progress, ectopic and cervical pregnancies .CSP can have grave consequences in all the three trimesters for the patient if not recognized early or appropriately treated.There are two types of CSP which have been reported. One in which there is a deep implantation in a cesarean scar defect towards the bladder and the abdominal cavity and the second type which involves an implantation ABSTRACT Background: Objective of present study was to describe evaluation and management of pregnancies implanted into uterine Cesarean section scars, Ceasarean scar pregnancies (CSP), is defined as gestational sac implanted in the myometrium at the site of a previous ceasarean scar. Also known as Ceasarean ectopic pregnancy. Methods: In all antenatal patients attending the antenatal outpatient department of a tertiary care service hospital a transvaginal sonography was done for determining the gestational age as well as the viability of the pregnancy. In all patients with a history of previous Cesarean section(s), special effort was made to assess the possibility of implantation into the uterine scar by means of an early transvaginal and colour doppler ultrasound. Results: Twelve Cesarean section scar pregnancies were diagnosed in a five-year period, of a tertiary care service hospital. Five (42%) patients with Cesarean scar pregnancies were treated surgically, four patients medically (33%), and two patients expectantly (17%) and one patient opted to continue the pregnancy. Surgical management was successful in all cases, although two of five (40%) women suffered bleeding (300-500ml). In the group of women who were managed medically the success rate was 3/4(75%). Expectant management was successful in one of two cases (50%). One patient who opted to continue pregnancy, underwent a ceasarean hysterectomy at 33 weeks of gestation for placenta accreta. Conclusions: Incidence of ceasarean section scar pregnancies is increasing as is the increasing rate of ceasarean deliveries. A high index of suspicion in all cases of post ceasarean pregnancies, coupled with early transvaginal ultrasonography along with colour doppler confirmation and institution of early and individualized treatment, optimizes the clinical outcome. Although rare, the patient and her relatives must be made aware of the possibility of recurrent CSP.

A rare case of caesarean scar ectopic pregnancy: a case report

“…Hysterectomy was done due to adherent placenta. 9 In another case report by Fatusic et al, scar ectopic pregnancy presented with severe bleeding per vaginum after 1 month of dilatation and curettage. Hysterectomy was done and histopathology revealed placenta percreta.…”