Ectopic Pregnancy in Lower Segment Uterine Scar

Abstract

In this retrospective case control investigation, 51 pregnant patients who were diagnosed by ultrasound with uterine myomas were compared to 102 randomly selected control patients to determine if the ultrasound diagnosis of one or more leiomyoma is associated with increased untoward pregnancy outcomes compared to controls. Women with uterine myomas were older (p = 0.001), more likely to be African American (p = 0.001), and undergo Caesarean delivery (p = 0.03) than controls. However, when women who underwent abdominal delivery for previous myomectomy (n = 5) were excluded from analysis, there was no significant difference in the incidence of Caesarean delivery. Overall, there was no difference in the incidence of obstetric complications between groups even when the data was stratified for large and/or multiple leiomyomas. The discovery of uterine leiomyomas by gestational ultrasound does not appear to place the patient at increased risk for preterm labour, early delivery, or other untoward pregnancy outcomes.

Cervico-isthmic pregnancy developing within the scar of a previous cesarean section: a case report

“…If the pregnant reported no clinical evidence of suffering, such us bleeding or abdominal pain, and the diagnosis is made at an early stage, we can consider a conservative management with systemic or local injection of methotrexate, potassium chloride, and hyperosmolar glucose [17,21,[27][28][29]. However, recent reports evidenced that the cases treated with local or systemic methotrexate, often required laparotomy due to massive hemorrhage [30].…”

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“…Magnetic resonance imaging (MRI) has been used as an adjunct to ultrasound scan, although not compulsory for the diagnosis [9,19,20]. It is notable that MRI is a costly diagnostic technique which has a long acquisition time, and mostly used for cases where TVUS and color flow Doppler are inconclusive [22].…”

“…It is notable that MRI is a costly diagnostic technique which has a long acquisition time, and mostly used for cases where TVUS and color flow Doppler are inconclusive [22]. Diagnostic hysteroscopy and diagnostic laparoscopy allows direct visualization and can be also therapeutic [20][21][22].…”

“…Besides, this route has no added advantage over systemic administration with regard to serum drug level and systemic toxicity. Other feticide/ embyrocides that have been used include potassium chloride [19], hyperosmolar glucose [20] and crystalline trichosanthin .Combined regimens have been described by many authors including; injecting potassium chloride into the gestational sac followed by methotrexate [27], simultaneous intravenous and intra-amniotic injections of MTX [28]. Complication rate is about 9.6% [12,18].…”

“…Moreover, the ability to achieve a subsequent term pregnancy was found to be related to successful hysterotomy. Surgical treatment has a number of advantages such as one-time lesion clearance and instantaneous repair of the scar, removes the microtubular tracts and thus reduces the risk of recurrence followed by a rapid return of the beta-hCG to normal level within 1-2 weeks, preservation of pa tient fertility, and no undesirable effect on menstruation [6,9,20]. Laparotomy followed by wedge resection of the lesion should be considered in women who present too late or if facilities and expertise for operative endoscopy are not available.…”