Cesarean Scar Pregnancies: A Systematic Review of Treatment Options

Maheux-Lacroix, Sarah; Li, Fiona; Bujold, Emmanuel; Nesbitt‐Hawes, Erin; Deans, Rebecca; Abbott, Jason

doi:10.1016/j.jmig.2017.05.019

Cited by 184 publications

(222 citation statements)

References 71 publications

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“…In another systematic review, side effects seen in various studies with methotrexate treatment were elevated liver enzymes (2%), suppression of bone marrow (2%), fever (1%) and oral ulcers (1%) 12. Our patients did not report any side effects following treatment.…”

Section: Discussionmentioning

confidence: 46%

Successful management of caesarean scar live ectopic pregnancies with local KCL and systemic methotrexate

Gupta

Kriplani

Mahey³

et al. 2017

BMJ Case Reports

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Two cases of live caesarean scar ectopic pregnancies are presented. Beta human chorionic gonadotropin (b-hCG) values in both patients at presentation were 50 099 mIU and 297 969 mIU, respectively. Both were managed with intrasac potassium chloride injection to induce fetal demise and multiple dose methotrexate therapy. The time for b-hCG to become negative in both patients was 91 days and 119 days, respectively. Successful management of live caesarean scar pregnancies even with very high b-hCG is possible with minimally invasive approach.

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Section: Discussionmentioning

confidence: 46%

Successful management of caesarean scar live ectopic pregnancies with local KCL and systemic methotrexate

Gupta

Kriplani

Mahey³

et al. 2017

BMJ Case Reports

View full text Add to dashboard Cite

show abstract

“…Only about 20% studies report CSP typing, and current typing methods are unsatisfactory for guiding clinical decisions. At present, there is still a lack of recognized standard treatment plans for CSP . CSD is the operative site; however, few studies investigate the relationship between diverticulum characteristics and risk of CSP, as well as clinical decision‐making.…”

Section: Discussionmentioning

confidence: 99%

A novel method for typing of cesarean scar pregnancy based on size of cesarean scar diverticulum and its significance in clinical decision‐making

Liu

Zhao

2020

J of Obstet and Gynaecol

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Aim: There is currently no universally accepted method for typing of cesarean scar pregnancy (CSP) to guide the choice of treatment approach. We introduce a new method for typing CSP and investigate its clinical significance. Method: Clinical data of 198 patients with CSP were collected and analyzed. The patients were divided into three types according to the size of their cesarean scar diverticula (CSD), measured by magnetic resonance imaging: type I (size of CSD ≤40 mm), type II (40 mm < size of CSD ≤70 mm) and type III (size of CSD >70 mm). Results: With increase in the type level, the risk of adverse events increased significantly (χ 2 = 36.345, P = 0.000). There was a significant difference in the choice of the treatment approaches in various types of the patients (χ 2 = 27.106, P = 0.000). With increase in the type level, the invasiveness level of the treatment approach increased significantly (R = 0.405, P = 0.000). Further analysis found two other factors that influenced treatment choice. Conclusion: Our study, for the first time, demonstrates the value of size of CSD in typing of CSP and, thereby supplements the CSP typing system with a novel quantitative indicator. This typing method is of significance for evaluation of risk of CSP and guiding the choice of treatment approach. This typing method, combined with the two features of cesarean scar thickness and lesions protruding outside the uterine contour, will improve the risk assessment of CSP and the rationale of treatment plan formulation for this condition.

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“…Although many management options have been proposed, there is no consensus on the preferred mode of treatment for CSP or CP. The treatment strategies remain highly varied [19]. Three therapeutic methods were applied as initial treatment in this study.…”

Section: Treatment Modalities For Csp and Cpmentioning

confidence: 99%

Intrauterine ectopic pregnancy — ultrasound typing and treatment

Jiang

Nong

et al. 2020

Ginekol Pol

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Objectives:To analyze the correlation between ultrasound typing and treatment modality of patients with an intrauterine ectopic pregnancy (cervical and cesarean scar). Material and methods:We retrospectively enrolled 65 patients diagnosed with cesarean scar pregnancy (CSP) or cervical pregnancy (CP) between February 2014 and May 2018. The cases were divided into two types according to the ultrasound presentation with a gestational sac (GS, type I) or a heterogeneous mass (HM, type II). Type I was further divided into type Ia (< 8 weeks) and type Ib (≥ 8 weeks); type II was defined as type IIa (with poor or no vascularity) and type IIb (with rich vascularity). Three treatment methods were applied in each group.Results: Of included cases, there were 53 CSP and 12 CP. There was no significant difference between Type I and Type II groups in any variable. The beta human chorionic gonadotropin (β-hCG) level and gestational age of type IIb were significantly higher compared to type IIa (p < 0.05). There was a positive correlation between ultrasound categories and treatment methods (rs = 0.723, p = 0.000). Analysis of CSP cases of initial treatment failure indicated success rate of initial dilation and curettage (D&C) was dependent upon ultrasonic types, mean sac diameter, gestational age, hCG level, and number of cesarean sections. Conclusions:The features of ultrasound imaging might provide an additional reference for the selection of clinical treatment methods.

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Cesarean Scar Pregnancies: A Systematic Review of Treatment Options

Cited by 184 publications

References 71 publications

Successful management of caesarean scar live ectopic pregnancies with local KCL and systemic methotrexate

Successful management of caesarean scar live ectopic pregnancies with local KCL and systemic methotrexate

A novel method for typing of cesarean scar pregnancy based on size of cesarean scar diverticulum and its significance in clinical decision‐making

Intrauterine ectopic pregnancy — ultrasound typing and treatment

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