Cesarean Scar Pregnancy: A systematic review on expectant management

Silva, Beatríz; Pinto, Pedro Viana; Costa, Antónia

doi:10.1016/j.ejogrb.2023.06.030

Cited by 17 publications

(18 citation statements)

References 64 publications

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“…Some projections show that by 2030 nearly 30% of all deliveries will by cesarean section [ 54 ]. Although there are reports of healthy deliveries among patients who received expectant management, it is associated with relatively high morbidity and mortality rates; therefore, termination of CSP is currently recommended [ 55 ]. Chemoembolization and systemic methotrexate are both treatments for cesarean scar pregnancy, but UAC might be contraindicated in patients with serious symptoms or complications (eg, vaginal bleeding or hemodynamic instability) [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Advances in Treating Cesarean Scar Pregnancy: A Comprehensive Review of Techniques, Clinical Outcomes, and Fertility Preservation

Kłobuszewski,

Szmygin,

Nieoczym

et al. 2024

Med Sci Monit

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Cesarean scar pregnancy (CSP) is a rare but potentially dangerous condition that occurs when an embryo implants and develops within the scar tissue from a previous cesarean section. Treatment of cesarean scar pregnancy depends on several factors, including the gestational age of the pregnancy, the presence of complications, and the individual patient’s circumstances. We performed a systematic review of the published literature on management of cesarean scar pregnancy and the outcomes, complications, and effects on fertility. A systematic review of recent scientific literature published up to April 2023 in the databases PubMed, Google Scholar, and Web of Science was performed according to the PRISMA guidelines. We used the search keywords “cesarean scar pregnancy,” “methotrexate,” “systemic,” “chemoembolization,” and “uterine artery embolization.” The baseline search resulted in 413 articles. After the exclusion of 342 irrelevant articles, the abstracts and titles of the remaining 71 articles were read for potential inclusion, resulting in exclusion of a further 16 articles. Therefore, the full texts of 55 articles were investigated. Finally, 42 papers were included in the study. The main finding was that chemoembolization is more successful than systemic methotrexate therapy, and is associated with less blood loss and shorter hospital stay. Transarterial chemoembolization appears to be safe and effective method of treatment in patients with CSP and should thus be considered during multidisciplinary evaluation of these patients.

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Section: Discussionmentioning

confidence: 99%

Advances in Treating Cesarean Scar Pregnancy: A Comprehensive Review of Techniques, Clinical Outcomes, and Fertility Preservation

Kłobuszewski,

Szmygin,

Nieoczym

et al. 2024

Med Sci Monit

View full text Add to dashboard Cite

show abstract

“…Then perpendicularly, the superior-inferior (S—I) diameter of the gestational sac is traced [ 15 , 16 ]. In COS-1, the gestational sac is implanted within the caesarean scar, and at least two-thirds of the S—I diameter of the gestational sac is above the endometrial line, towards the anterior uterine wall, and in COS-2 less than two-thirds of the S—I diameter is above the endometrial line [ 4 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…A systematic review by Silva et al (2023) concludes Type 1 CSP has a significantly better outcome than Type 2, namely in gestational age at delivery, PAS diagnosis, requirement for hysterectomy and risk of uterine rupture [ 4 ]. The same correlation also verifies for COS-1 and COS-2 classifications.…”

Section: Discussionmentioning

confidence: 99%

“…The estimated incidence of CSP ranges from 1 in 1800 to 1 in 2216 pregnancies [ 2 , 3 ]. However, the increasing prevalence of caesarean deliveries suggests there will be a rise in CSP cases and associated complications [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Upon CSP diagnosis, individuals should receive counselling about the risk of severe morbidity and be presented with options for terminating the pregnancy, ideally performed in the first trimester [ 6 ]. However, for those who choose not to terminate, significant uncertainty surrounds the optimal course of treatment [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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