Outcomes of reproduction following cesarean scar pregnancy treatment: A systematic review and meta-analysis

Wu, Jiawen; Ye, Jianbin; OuYang, Zhenbo; Wan, Zixian; Zhang, Qiushi; Zhong, Biting; Wei, Shiyuan

doi:10.1016/j.ejogrb.2021.05.010

Cited by 25 publications

(25 citation statements)

References 57 publications

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“…The main advantage of the laparoscopic approach is the complete removal of the retained products of conception at the time of the surgery leading to a less prolonged follow-up [13]. Moreover, restored uterine anatomy of the lower segment augments favorable future fertility outcomes [40]. Although representing a reliable treatment approach, it should be performed by skilled laparoscopic surgeons.…”

Section: Discussionmentioning

confidence: 99%

“…A recent meta-analysis by Wu et al of 32 articles, which were reviewed systematically, including a population of 3380 individuals having CSP history, investigated the reproductive outcomes of women as well as how treatments approaches used might affect subsequent pregnancy outcomes. The authors concluded that these individuals are at higher risk for ectopic pregnancy (16.6%), with recurrent CSP rates and risk for spontaneous miscarriages in cured CSP cases being significantly increased in subsequent pregnancies; therefore, contraception should be recommended in those patients who do not wishing future fertility [4,40]. Based on the available evidence, the authors conclude that any plausible elucidation of how treatment approaches and modalities affect subsequent pregnancies in previous CSP cases seems unfeasible until larger prospective studies are undertaken [40].…”

Section: Discussionmentioning

confidence: 99%

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Caesarean Scar Pregnancy: A Case Report and a Literature Review

Valasoulis

Magaliou²,

Koufidis³

et al. 2022

Medicina

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Background and Objectives: Caesarean scar pregnancy (CSP) refers to placental implantation on or in the scar of a previous caesarean section and represents a potentially life-threatening condition. CSP is considered a diagnostic challenge in obstetrics, with the diagnosis relying mainly on transvaginal ultrasound (TVS) and the management depending upon case presentation and available healthcare infrastructures. Case Presentation: We present a case of 34-year-old G3P2 with a history of two-previous caesarean sections referred to the outpatient gynaecology clinic of our Department at the 7th week (7/40) of gestation with abnormal early pregnancy TVS findings, illustrating the gestational sac attached to the caesarean scar and a foetal pole with evidence of foetal cardiac activity. We discuss the outcome of an alternative combined medical and surgical approach we followed as well as an updated review of the current literature. Conclusions: The ideal management of CSP requires tertiary centers, equipment availability and experienced healthcare professionals capable of dealing with any possible complication, as well as individualized treatment based on each case presentation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Caesarean Scar Pregnancy: A Case Report and a Literature Review

Valasoulis

Magaliou²,

Koufidis³

et al. 2022

Medicina

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“…Women with a history of CSP still have a high pregnancy rate, but the risk of recurrence and miscarriage is also increased [ 23 , 24 ]. The effect of different treatments on subsequent pregnancy is unclear [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…There is a need to further evaluate whether cesarean section scar resection and repair can improve reproductive outcomes [ 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Conservative Management of Cesarean Scar Pregnancy: A Case Report and Literature Review

Sánchez‐Prieto

Puy

Barbany

et al. 2022

Case Reports in Obstetrics and Gynecology

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Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy located in the lower uterine segment. The current increase in the percentage of cesarean sections is accompanied by significant growth in the incidence of CSP, while advances in ultrasound diagnostic techniques have led to a greater number of CSP diagnoses. A misdiagnosed CSP, or one that is diagnosed too late, is life-threatening to the pregnant patient and predisposes her to complications such as uterine bleeding or rupture, which often require hysterectomy and thus result in the irreversible loss of fertility. We present the case of a 50-year-old woman with a history of undiagnosed CSP after multiple consultations for intermittent bleeding and hemorrhage. She was diagnosed by ultrasound and the diagnosis was confirmed by hysteroscopy. She underwent conservative medical treatment that was successful.

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“…Curettage alone or systemic methotrexate administration, as well as expectant management, are strongly considered unsuitable because of the high morbidity and mortality maternal risks (hemorrhage, perforation, development of uterine arteriovenous malformation, etc. [ 7 , 8 , 9 , 10 , 11 ]). However, there is no consensus for the optimal treatment regime, and different situations require different approaches [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Uterine Artery Embolization Combined with Subsequent Suction Evacuation as Low-Risk Treatment for Cesarean Scar Pregnancy

Bohîlțea

Ducu

Mihai³

et al. 2021

Diagnostics

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Objective: The aim of this study is to propose a standardized management of care for patients diagnosed with cesarean scar pregnancy (CSP). There are two types of CSP: Type 1 (on the scar) vs. type 2 (in the niche). To date there is no international standard to predict the extent of invasion or the optimal management of CSP. Materials and methods: We used intramuscular methotrexate injection followed by uterine artery embolization combined with suction evacuation as a conservative approach for the treatment of seven patients diagnosed with CSP. Our inclusion criteria, to be satisfied simultaneously, were established as follows: (1) patients with CSP; (2) early gestational age ≤ 9 weeks, and (3) written consent of the proposed treatment of the patient. Results: This course of treatment produced a positive outcome in all cases. We did not have any complications (e.g., emergency hysterectomy, perforation of the uterine cavity, severe hemorrhage, or endometritis) during the procedures or in the follow-up. The most important predictors of successful management are early diagnosis of CSP and orientation of the invasive trophoblast opposite to the scar. Conclusions: The main finding from this series of cases is that associating systemic methotrexate and uterine artery embolization provides efficient and low-risk management of CSP. This treatment regime is adequate for both types of CSPs. We consider that early localization diagnosis of pregnancy following a cesarean delivery is mandatory for CSP morbidity prevention.

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Outcomes of reproduction following cesarean scar pregnancy treatment: A systematic review and meta-analysis

Cited by 25 publications

References 57 publications

Caesarean Scar Pregnancy: A Case Report and a Literature Review

Caesarean Scar Pregnancy: A Case Report and a Literature Review

Conservative Management of Cesarean Scar Pregnancy: A Case Report and Literature Review

Uterine Artery Embolization Combined with Subsequent Suction Evacuation as Low-Risk Treatment for Cesarean Scar Pregnancy

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