Hysteroscopic treatment of Cesarean Scar Pregnancy: A systematic review

Diakosavvas, Michail; Kathopoulis, Nikolaos; Angelou, Kyveli; Chatzipapas, Ioannis; Zacharakis, Dimitrios; Kypriotis, Konstantinos; Grigoriadis, Themos; Πρωτόπαπας, Αθανάσιος

doi:10.1016/j.ejogrb.2021.12.038

Cited by 12 publications

(10 citation statements)

References 51 publications

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“… 54 , 55 A recent systematic review revealed that hysteroscopic treatment after HIFU or UAE resulted in 91% resolution of CSP. 53 Larger studies are required to further assess the safety of hysteroscopic treatment.…”

Section: Treatmentmentioning

confidence: 99%

Overview of ectopic pregnancy diagnosis, management, and innovation

Mullany

Minneci

Monjazeb

et al. 2023

Womens Health (Lond Engl)

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Ectopic pregnancies are the leading cause of maternal mortality in the first trimester, with an incidence of 5%–10% of all pregnancy-related deaths. Diagnosis of ectopic pregnancies is difficult due to clinical mimics and non-specific symptoms of abdominal pain and vaginal bleeding. The current standard for ectopic pregnancy diagnosis includes ultrasound imaging and β-human chorionic gonadotropin (β-hCG) monitoring. In addition to β-hCG, serum markers are being explored as a potential for diagnosis, with activin-AB and pregnancy-associated plasma protein A specifically showing promise. Other diagnostic methods include endometrial sampling, with dilation and curettage showing the highest specificity; however, frozen section reduces the diagnostic timeline which may improve outcomes. Treatment options for confirmed ectopic pregnancies include medical, surgical, and expectant management. Chosen treatment methodology is based on β-hCG levels, hematologic stability, and risk of ectopic pregnancy rupture. Current innovations in ectopic pregnancy management aim to preserve fertility and include laparoscopic partial tubal resection with end-to-end anastomosis and uterine artery embolization with intrauterine infusion of methotrexate. Psychological interventions to improve patient mental health surrounding ectopic pregnancy diagnosis and treatment are also valuable innovations. This literature review aims to bring light to current ectopic pregnancy diagnostics, treatments, and future directions.

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Section: Treatmentmentioning

confidence: 99%

Overview of ectopic pregnancy diagnosis, management, and innovation

Mullany

Minneci

Monjazeb

et al. 2023

Womens Health (Lond Engl)

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“…Several methods for resection of the CSEP have been described in the literature. Hysteroscopic resection has been found to have a high success rate (88% in two meta-analysis), with a low risk of complication [16,23,24 ▪ ,25]. Hysteroscopic resection of residual avascular trophoblastic tissue after treatment with methotrexate and follow-up has also been reported to produce good results [26].…”

Section: Surgical Managementmentioning

confidence: 99%

“…Hysteroscopic resection of residual avascular trophoblastic tissue after treatment with methotrexate and follow-up has also been reported to produce good results [26]. Numerous hysteroscopic methods have been described including using the hysteroscopic morcellator or the resectoscope for normalization of the lower uterine segment [24 ▪ ,26–28].…”

Section: Surgical Managementmentioning

confidence: 99%

An update and review of nontubal ectopic pregnancy management

Kostroun

Robinson

2023

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of review Nontubal ectopic pregnancies appear to be increasing in prevalence. Increasingly, minimally invasive methods for management are being utilized. A current literature review and recommendations for management of nontubal ectopic pregnancy is presented in this review. Recent findings Nontubal ectopic pregnancies are less common than tubal ectopic pregnancies but present a unique and significant threat to patient's health and are optimally managed by specialists familiar with the condition. Early diagnosis, prompt treatment and close follow-up to resolution are critical. Recent publications focus on fertility-sparing and conservative management through the use of medications both systemic and local; as well as minimally invasive surgical techniques. The Society of Maternal Fetal Medicine recommends against expectant management of cesarean scar pregnancies; however, optimal treatment is unknown and this holds true for management of other nontubal ectopic pregnancies. Summary Minimally invasive and fertility sparing management should be the mainstay in treatment of stable patients with nontubal ectopic pregnancy.

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“…Due to the similar lesion location and bleeding risk, the successful treatment experiences of cesarean scar pregnancy (CSP) can help inform the treatment strategy for GTN in the cesarean scar. After the pretreatment with uterine artery embolization (UAE) or high intensity focused ultrasound (HIFU), hysteroscopic procedure is a safe and effective procedure for the management of CSP [ 10 , 11 ]; the reported rates of excessive hemorrhage (> 500 mL) and hysterectomy were 1.66% and 0.28%, respectively. Combined UAE—hysteroscopic diode laser surgery is feasible and safe without anesthesia and cervical dilatation [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Long-term outcome of ultrasound-guided focused ultrasound ablation for gestational trophoblastic neoplasia in the cesarean scar: a case report

Chen

Jiang

et al. 2022

BMC Women's Health

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Background The treatment of gestational trophoblastic neoplasia (GTN) is one of the success stories in medical oncology. GTN in the cesarean scar is a rare entity, but most cases need to be treated with hysterectomy or localized uterine lesion resection because of chemoresistant lesions and/or massive bleeding. We present a patient with post-molar GTN in the cesarean scar who was non-invasively treated with ultrasound-guided high intensity focused ultrasound (HIFU) to preserve the uterus and fertility. Case presentation A 32-year-old woman was diagnosed with low-risk GTN (FIGO Stage I: 2 prognostic score) after partial hydatidiform mole. The 5th cycle of chemotherapy was interrupted because of persistent hepatic toxicity and impaired ovarian reserve function. However, the uterine lesion persisted (diameter of residual uterine lesion in the cesarean scar: 2.0 cm). Therefore, ultrasound-guided HIFU treatment was performed. A significant gray-scale change was observed during the HIFU treatment. Color Doppler ultrasonography and contrast-enhanced ultrasound (CEUS) was performed to evaluate the ablation effectiveness. Color Doppler ultrasonography showed disappearance of the signal of vascularity and CEUS showed no perfusion in the lesion located in the cesarean scar. The uterine lesion was obviously shrunken one month after HIFU treatment. Menstrual cycle resumed 48 days after HIFU. HIFU treatment decreased the number of chemotherapy cycles and there was complete disappearance of the GTN lesion at 4-month follow-up. The patient has shown no signs of recurrence as of 58-month follow-up. Conclusion Ultrasound-guided HIFU may be a useful alternative to lesion resection for GTN in the cesarean scar in patients who show chemoresistance or are not suitable for chemotherapy. It has the potential to ablate the residual uterine lesion noninvasively to preserve the uterus and fertility, avoiding perioperative risks of lesion resection, especially acute bleeding.

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Hysteroscopic treatment of Cesarean Scar Pregnancy: A systematic review

Cited by 12 publications

References 51 publications

Overview of ectopic pregnancy diagnosis, management, and innovation

Overview of ectopic pregnancy diagnosis, management, and innovation

An update and review of nontubal ectopic pregnancy management

Long-term outcome of ultrasound-guided focused ultrasound ablation for gestational trophoblastic neoplasia in the cesarean scar: a case report

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