Cesarean scar ectopic pregnancy: invasion of the bladder wall detected by magnetic resonance imaging

Caserta, Nelson Marcio Gomes; Bacha, Angela Maria; Grassiotto, Oswaldo Rocha

doi:10.1590/0100-3984.2014.1855

Cited by 5 publications

(5 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A variety of dosages of MTX, such as 50 mg/m 2 [ 4 , 5 ], 1 mg/kg one-time systemic dose [ 7 ], various intra-gestational sac dosages, multi-dose regimens alternating with folinic acid [ 3 , 10 ] have been reported. Administration of MTX was found to be ideal for those who presented before eight weeks gestation, with b-hCG concentration of <1200 mIU/mL and absent FCA [ 14 ]. Often different MTX regimens were used sequentially if there was not an appropriate drop in b-hCG after the first dose.…”

Section: Discussionmentioning

confidence: 99%

“…Many methods have been described to manage CSP including expectant management [ 4 ], systemic or intra-gestational sac MTX, hysteroscopic suction, dilation and curettage (D&C), uterine artery embolization (UAE), hysteroscopy or D&C, hysteroscopic (MyoSure) resection [ 2 ], wedge resection and uterine repair, hysterectomy, and different combinations of the above [ 2 - 4 , 7 , 9 - 14 ]. In a systematic review of 32 studies including 3380 CSP patients, 583 patients were able to successfully conceive following fertility-sparing management of their initial CSP [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cesarean Scar Pregnancy With Surgical and Conservative Managements: A Case Report

Shoai,

Gibbs,

Leonis

2024

Cureus

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cesarean Scar Pregnancy With Surgical and Conservative Managements: A Case Report

Shoai,

Gibbs,

Leonis

2024

Cureus

View full text Add to dashboard Cite

show abstract

“…An MRI can better distinguish between them by more clearly distinguishing the location of the gestational sac [ 42 ] and detecting the presence of any deep stromal infiltration of the cervix [ 43 ]. Furthermore, MRI is superior to ultrasound in distinguishing the myometrial thinning between the sac and the bladder, which is characteristic of CSEP [ 44 ], and in detecting CSEP invasion into the bladder wall [ 45 ]. In some LMIC settings, MRI, through its ability to better characterize soft tissue and provide more detailed anatomical information, may allow physicians to consider minimally invasive procedures such as uterine artery embolization as a first-line treatment [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

Use of Magnetic Resonance Imaging (MRI) in the Management of Diagnostic Uncertainty in Low-Resource Settings: A Case Report of Cesarean Ectopic Pregnancy in a Tertiary Hospital in Ghana

et al. 2020

View full text Add to dashboard Cite

“…11). 26,27 T2-weighted imaging provides the best overview when evaluating a potential C-section pregnancy 21,28 . Magnetic resonance imaging findings include an absent or thinned myometrium between the gestational sac and bladder wall, an empty uterus/cervical canal, gestational sac formation in the anterior portion of the lower uterine segment, or enlargement of the cesarean scar and presence of the gestational sac within the site of the scar 21 …”

Section: Cesarean Pregnancymentioning

confidence: 99%

Magnetic Resonance Imaging Evaluation of Ectopic Pregnancy: A Value-Added Review

Gopireddy

Virarkar

et al. 2021

J Comput Assist Tomogr

View full text Add to dashboard Cite

Ectopic pregnancy (EP) is a known cause of maternal mortality and may be misdiagnosed in up to 50% of pregnant female individuals (Ann Emerg Med. 1996;28(1):10-17). Magnetic resonance imaging, with its superior soft tissue resolution, is a valuable alternative diagnostic modality to diagnose EP when transvaginal ultrasound results are inconclusive. Although an extrauterine gestational sac is the most specific finding, there are other key MRI findings that can aid in diagnosing EP. As availability of MRI access in the emergency department setting increases across the nation, its utility in women with a positive pregnancy test has also increased. Specific MRI findings that are diagnostic of EP include absence of intrauterine pregnancy, adnexal mass separate from the ovary, and hemoperitoneum. In addition, intrauterine ectopic locations, especially intramural, cornual, and cervical pregnancies, can be diagnosed with increased accuracy with the help of MRI. Magnetic resonance imaging is also useful in excluding potential mimics of EP, including adnexal cysts, ovarian neoplasms, and fibroids. In summary, providing an accurate diagnosis and determining the precise location of an EP, which is supported by the use of MRI, is imperative for guiding a patient's treatment to prevent a potentially fatal outcome.

show abstract

Cesarean scar ectopic pregnancy: invasion of the bladder wall detected by magnetic resonance imaging

Cited by 5 publications

References 8 publications

Cesarean Scar Pregnancy With Surgical and Conservative Managements: A Case Report

Cesarean Scar Pregnancy With Surgical and Conservative Managements: A Case Report

Use of Magnetic Resonance Imaging (MRI) in the Management of Diagnostic Uncertainty in Low-Resource Settings: A Case Report of Cesarean Ectopic Pregnancy in a Tertiary Hospital in Ghana

Magnetic Resonance Imaging Evaluation of Ectopic Pregnancy: A Value-Added Review

Contact Info

Product

Resources

About