Reproductive outcomes of women with a previous history of Caesarean scar ectopic pregnancies

Abstract

BACKGROUND: Caesarean scar ectopic pregnancy is associated with a number of significant complications. In this study, we report on subsequent reproductive outcomes in a group of women following successful treatment of their scar pregnancies. METHODS: The study included those women who received treatment for their Caesarean scar pregnancies between April 1999 and October 2005. Their ability to conceive, the time it took to become pregnant and outcomes of subsequent pregnancies were all recorded. RESULTS: 40 women with Caesarean scar pregnancies were managed in our unit. The uterus was conserved in 38/40 cases. Follow-up data were available in 29/38 (76%) of women. Twenty-four out of 29 (83%) attempted to become pregnant. Twenty-one out of 24 [88%, 95% confidence interval (CI): 75-100] women conceived spontaneously. Twenty out of 21 (95%, 95% CI: 86-100) pregnancies were intrauterine and one woman (5%, 95% CI: 0-14) had a recurrent scar ectopic. Thirteen out of 20 (65%, 95% CI: 44-86) intrauterine pregnancies appeared normal. Nine out of 13 (69%) were delivered by Caesarean section. Seven out of 20 (35%, 95% CI: 14-56) intrauterine pregnancies ended in spontaneous abortions. CON-CLUSIONS: Our study shows that reproductive outcomes following treatment of caesarean scar ectopic pregnancies are favourable. The risk of complications including recurrent scar implantation appears to be low.

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

“…Herman et al [4] reported a case of pregnancy implanted on previous cesarean section, which carried to a hysterectomy because of the development of a profound hemorrhage and disseminated intravascular coagulopathy. All these conditions can lead inevitably to fertility loss and to long-term side effects, which decrease the quality of life [7]. In this current report, we describe a case of a woman with isthmic pregnancy developed in a cesarean section scar and successfully treated with conservative management despite an initial erroneous diagnosis of cervical pregnancy.…”

Suction Evacuation with Methotrexate as a Successful Treatment Modality for Caesarean Scar Pregnancies: Case series

“…A follow-up study of 29 women who were successfully treated for CSP reported favourable reproductive outcomes and a low recurrence rate. 28 Out of 24 women attempting to become pregnant, 21 conceived spontaneously (20 intrauterine pregnancies and one recurrent CSP); of the intrauterine pregnancies, 13 were normal (nine of which were delivered by Caesarean section) while seven ended in spontaneous miscarriages. 28 Using sonohysterography, the integrity of the uterine wall post-Caesarean section can be determined even in non-pregnant patients.…”

“…28 Out of 24 women attempting to become pregnant, 21 conceived spontaneously (20 intrauterine pregnancies and one recurrent CSP); of the intrauterine pregnancies, 13 were normal (nine of which were delivered by Caesarean section) while seven ended in spontaneous miscarriages. 28 Using sonohysterography, the integrity of the uterine wall post-Caesarean section can be determined even in non-pregnant patients. 2,29 Caesarean scar defects, defined by the presence of fluid within the incision site, or any filling defects at the presumed scar site might indicate uterine scar complications in a subsequent pregnancy.…”

Laparoscopic Treatment of Caesarean Scar Pregnancy

“…Internal iliac ligation with partial lesion resection and uterine neoplasty has significant advantages in the surgical treatment of CSPs. 14 Huanxiao et al, 15 reported 40 cases of CSP and recommended a transvaginal hysterotomy approach for removal of the ectopic tissue and repair of the uterine defect. The approach is safe, cost effective, less postoperative pain and blood loss and shorter hospital stay.…”