Placenta Increta Complicating Persistent Cesarean Scar Ectopic Pregnancy following Failed Excision with Subsequent Preterm Cesarean Hysterectomy

Abstract

Introduction. Cesarean scar pregnancies (CSPs) are one of the rarest forms of ectopic pregnancy. Given their rarity, there is lack of consensus regarding the management and natural course of CSPs. Case. A 37-year-old G10 P3063 female with a history of two prior cesarean deliveries was diagnosed with her second CSP at 6 weeks and 5 days in her tenth pregnancy. The patient underwent vertical hysterotomy, excision of a gestational sac implanted in the cesarean sac, and bilateral salpingectomy via a laparotomy incision. The histopathology report confirmed immature chorionic villi. The patient returned 10 weeks later and was found to be still pregnant. Obstetric ultrasound confirmed a viable fetus of 19 weeks and 4 days of gestational age with a thin endometrium and an anteroposterior and right lateral placenta with multiple placental lakes. The patient ruptured her membranes at 31 weeks of gestation and pelvic MRI revealed an anterior placenta invading the myometrium and extending to the external serosal surface consistent with placenta increta. Following obstetric interventions, a live female infant was delivered by cesarean hysterectomy (because of placenta increta) at 32 weeks of gestation. Conclusion. Development of standardized guidelines for management of CSPs, as well as heightened vigilance for possible complications, is required for proper care and avoidance of potential morbidity and mortality.

Placenta accreta spectrum disorder trends in the context of the universal two‐child policy in China and the risk of hysterectomy

“…Therefore, the possibility that the PAS disorders among rural women had developed from cesarean scar pregnancies (CSPs) cannot be ruled out, because these women did not have early prenatal ultrasound data. In fact, some researchers believe that CSPs and PAS disorders are not a separate entity, but rather a continuum of the same condition . Because CSPs are often considered to be ectopic pregnancies, they are frequently aborted by surgical or medical means.…”

“…Because CSPs are often considered to be ectopic pregnancies, they are frequently aborted by surgical or medical means. If managed expectantly, CSPs are likely to evolve into placenta accreta or placenta percreta, and end in preterm delivery and hysterectomy in nearly all reported cases . As medical personnel, we should improve our surgical skills when a cesarean delivery is inevitable.…”

“…In fact, some researchers believe that CSPs and PAS disorders are not a separate entity, but rather a continuum of the same condition. 20,21 Because CSPs are often considered to be ectopic pregnancies, they are frequently aborted by surgical or medical means. If managed expectantly, CSPs are likely to evolve into placenta accreta or placenta percreta, and end in preterm delivery and hysterectomy in nearly all reported cases.…”

Scar Tissue after a Cesarean Section—The Management of Different Complications in Pregnant Women

“…In our first patient, most of the inclusion criteria for CSP mentioned above were obtained during the scan at 6 wks, so the diagnosis was made correctly [5]. In the opinion of many authors, in the second or third trimester of pregnancy, cases of CSP are almost indistinguishable from an ingrown placenta [21,22]. Therefore, it is crucial to perform the first scan with particular discernment [23].…”

Ultrasound signs in the diagnosis of placental anomalies: placenta accreta at the level of the uterine scar

“…Approximately 80% of the cases of placental abnormalities are associated with a history of Caesarian delivery, curettages or myomectomies with the opening of the uterine cavity. The pregnancy inserted or developed at the level of the post Caesarian section scar is also a precursor of abnormal placental adherence (4).…”