Society for Maternal-Fetal Medicine Consult Series for cesarean scar pregnancy: each treatment option has its indications

OuYang, Zhenbo; Wu, Jiawen; Zhong, Biting

doi:10.1016/j.ajog.2020.09.029

Cited by 5 publications

(4 citation statements)

References 3 publications

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“…Although the relative risk of maternal morbidity from the expectant management of CSP without cardiac activity is low, the risk of uterine rupture is as high as 13.4% [ 14 ]. The 2020 Society for Maternal-Fetal Medicine guideline also recommends against the expectant management of CSP (Grade 1B) [ 15 ].…”

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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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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“…Although the exact pathogenesis of CSP remains unclear, increasing research on this complication has indicated three possible scenarios: first, implantation of a blastocyst on the surface of a well-healed Cesarean scar; second, implantation of a blastocyst in a deficient or dehiscent Cesarean scar (niche); and third, implantation of a blastocyst within a microscopic dehiscence tract in the Cesarean scar (well-healed scar or deficient scar) 2,3 . It is important to understand the pathogenesis of CSP, because different pathogeneses may account for different types of CSP, which directly determines the pregnancy outcome and treatment options.…”

Section: Pathogenesis and Classification Of Cesarean Scar Pregnancy: ...mentioning

confidence: 99%

“…When the blastocyst is implanted in a niche, the GS tends to grow out of the uterine cavity, but does not protrude out of the serosal layer. When the blastocyst is implanted within a microscopic dehiscence tract in the Cesarean scar, the GS tends to grow out of the serosa (similar to an intramural pregnancy) 2,3 . Of course, we fully agree with an important point of the consensus that the classification of CSP may change with advancing gestation 1 .…”

Section: Pathogenesis and Classification Of Cesarean Scar Pregnancy: ...mentioning

confidence: 99%

Pathogenesis and classification of Cesarean scar pregnancy: getting closer to the truth

OuYang

Wan

2022

Ultrasound in Obstet & Gyne

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“…First, this study is a single‐center retrospective study with a small sample, and without clear diagnostic criteria and classification for CSP, which is very important for the selection of CSP treatment strategy 2 …”

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confidence: 99%

Letter to the editor: Medical treatment of cesarean scar ectopic pregnancies

OuYang

Liu

2023

Intl J Gynecology & Obste

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We read the article by Toh et al. 1 with great interest. The study concludes that cesarean scar ectopic pregnancy (CSP) may be managed both surgically and medically. At institutions where surgical expertise is unavailable, medical management would be valuable, with few adverse outcomes identified. However, as far as we know, the value of medical treatment of CSP still needs to be further explored.First, this study is a single-center retrospective study with a small sample, and without clear diagnostic criteria and classification for CSP, which is very important for the selection of CSP treatment strategy. 2 Second, there is currently a lack of recognized drug regimen for the medical treatment of CSP. The guidelines of the Society for Maternal-Fetal Medicine (SMFM) in 2022 suggest intragestational methotrexate (MTX) for the medical treatment of CSP, with or without other treatment modalities (GRADE 2C), and recommends that systemic MTX alone should not be used to treat CSP (GRADE 1C). 3 However, most of the patients in this study used systemic MTX.Third, as stated in meta-analysis and in the SMFM guidelines, surgical treatment should be the first-line treatment for CSP. 3,4 At present, there are many reported surgical treatment modalities, but operative resection (with transvaginal or laparoscopic approaches) should be considered for the surgical management of CSP, and sharp curettage alone should be avoided (GRADE 2C). 3 Compared with medical treatment, operative resection has the advantages of higher success rate, faster recovery, and shorter follow-up time. 3,4 However, of the six patients who were treated surgically in this study, two were treated with suction dilation and curettage, and two with laparotomy.Fourth, the initial treatment of CSP is very important. Improper initial treatment will complicate subsequent treatment. Because every CSP should receive appropriate initial treatment, we believe that for institutions that are not resourced for surgical treatment, patients should be referred promptly rather than receiving medical treatment. 3 Fifth, although there is little evidence of pregnancy outcomes after CSP treatment, the incidence of recurrent CSP (RCSP) is not as low as the author thinks. Our meta-analysis showed that the incidence of RCSP was 15.3%, and the incidence of spontaneous abortion in subsequent intrauterine pregnancy was 14.6%. 5 Therefore, effective contraception should be in place those who are not planning pregnancy, and supervision should be strengthened for those who have fertility requirements.The choice of CSP treatment should be personalized. Surgical treatment, rather than medical treatment, should be the first-line treatment for CSP. At institutions where surgical expertise is unavailable, timely referral of patients should be considered. For medical treatment of CSP, the specific drug regimen, indication, and impact on subsequent fertility need further research and exploration.

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Society for Maternal-Fetal Medicine Consult Series for cesarean scar pregnancy: each treatment option has its indications

Cited by 5 publications

References 3 publications

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

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

Pathogenesis and classification of Cesarean scar pregnancy: getting closer to the truth

Letter to the editor: Medical treatment of cesarean scar ectopic pregnancies

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