Cesarean section scar pregnancy may be the cause of serious hemorrhage after first‐trimester abortion by dilatation and curettage

Hysteroscopic management of cesarean scar ectopic pregnancy

“…Other investigators (6,(15)(16)(17)(18) have described intrasac aspiration and injection of embryocides, resulting in higher success rates as a primary procedure, which is further improved by a combination of systemic and local injection of embryocides. Other more novel approaches include uterine artery embolization as a single procedure or in combination with systemic MTX (19)(20)(21)(22). Medical management is less invasive for the patient, but the extended surveillance time, the prolonged return time of bhCG to normal, and resolution of local scar mass are problematic and may not be acceptable for patients or health care providers.…”

Caesarean scar pregnancy

“…Notwithstanding this, the lack of direct visualisation, risk of a local haematoma formation and the need for a prolonged β‐hCG follow up remain the major drawbacks, 33,52 and more reports are needed to rationalise this treatment modality 52 . Conversely, serious bleeding after an otherwise uncomplicated dilatation and evacuation procedure for a missed or therapeutic abortion in a woman with a previous CS should raise alarm for a CSP 54 …”

“…Without a high index of suspicion and correct early diagnosis, like other ectopic pregnancies, this abnormal implantation can lead to uterine rupture and/or hysterectomy, with consequent maternal morbidity and loss of future fertility. Furthermore, if the location of such an implantation is misdiagnosed, a common gynaecological operation such as dilatation and curettage can be met with catastrophic haemorrhage 6,54 . Ultrasonographers should follow strict imaging criteria to assess any pregnancy implanted on a previous caesarean section scar.…”

“…52 Conversely, serious bleeding after an otherwise uncomplicated dilatation and evacuation procedure for a missed or therapeutic abortion in a woman with a previous CS should raise alarm for a CSP. 54 Various haemostatic measures have been used successfully as an adjunct to conservative treatment of viable CSPs for the prevention and control of profuse bleeding, e.g. local injection of vasopressin, 20 intrauterine balloon tamponade by Foley catheter (30-90 ml of balloon capacity for 12-24 hours), 4,20 Shirodkar suture, 55 prior selective bilateral uterine artery embolisation 48,56,57 and bilateral uterine artery liagtion.…”

Grossesse sur cicatrice de césarienne : traitement combiné avec embolisation des artères utérines avant procédure chirurgicale

“…Dans cette sé rie, les pertes sanguines n'é taient cependant pas disponibles. L'A&C seule faisant suite à un retard ou dé faut de diagnostic initial, potentiellement hé morragique chez ces patientes, est à dé conseiller [30,31].…”