Uncommon Type of Placentation After Previous Cesarean Deliveries

Krasznai, I; Rigó, János; Böze, Tamás; Papp, Zoltán

doi:10.1097/00006250-200309000-00022

Cited by 7 publications

(4 citation statements)

References 3 publications

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“…From 1978 to July 2004, 75 cases have been reported in the English literature and treatment has included conservative ultrasound guidance suction curettage, excision of the mass of the ectopic pregnancy and hysterectomy. Successful cases have been reported after administration of systemic methotrexate (MTX), ultrasound guidance direct injection of MTX or potassium chloride (KCl) into the embryonic sac or just expectant management 1–13 …”

Section: Discussionmentioning

confidence: 99%

Caesarean scar pregnancy successfully treated by operative hysteroscopy and suction curettage

Wang

Yuen

Chao

et al. 2005

BJOG

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Case reportA 36 year old woman, gravida 5, para 2, was admitted seven weeks and three days after her last menstrual period because a transvaginal ultrasound examination showed a gestational sac with yolk sac and fetal cardiac activity located within the isthmic area of the lower anterior wall of the uterus and protruding toward the vesicouterine junctional region. This appearance raised the suspicion of a caesarean scar pregnancy (CSP). Both ovaries appeared normal and there were no adnexal masses or free fluid in the cul-de-sac. The plasma b-human chorionic gonadotrophin (b-hCG) level was 28,338 miu/mL and general physical examination was normal. Her obstetric history revealed two-term transverse lower segment caesarean sections and two uterine curettages for abortion, and her youngest child was five years old.After counseling, the patient opted for conservative treatment with diagnostic and operative hysteroscopy. Under general anaesthesia without endotracheal intubation, the patient was placed in the dorsolithotomy position. After a speculum was placed inside the vagina, a tenaculum was applied to the cervix and gentle traction was exerted to align the uterus. The cervix was dilated by Hegar dilators to 12 mm and a continuous flow 26F hysteroscopic resectoscope (Karl Stortz, Tuttlingen, Germany) with a 90j wire loop electrode was introduced under ultrasound control. Uterine distension was achieved using 10% dextrose solution propelled by simple gravity. An Aspen Excalibur (Aspen Labs, Englewood, Colorado) electrosurgical generator was used on a setting of 80 W of cutting waveform current and 100 W of coagulation current.The intervention began by an overview of the uterine cavity. The endometrial cavity was empty and the gestation sac was implanted in a niche located in anterior endocervical wall, compatible with prior caesarean section scar (Fig. 1). The sac was pushed toward the fundal direction via wire loop electrode and blood vessels in the implantation site were identified. These vessels were coagulated by loop electrode and the resectoscope was then withdrawn. A placenta forceps followed by a vacuum curette were used to remove the partial detached gestational tissue under the ultrasound guidance. Thereafter, the resectoscope attached with a rollerball was introduced again to achieve haemostasis. During the 20-minute procedure, total fluid input was 3200 mL and output was 3150 mL. Vaginal bleeding was minimal at the end of the procedure. The patient had an unremarkable post-operative course and was discharged on the next day. The plasma b-hCG level was 5211 and 593 miu/mL at post-operative days 1 and 7, respectively. The pathology report confirmed a CSP. Urine pregnancy test was negative and plasma b-hCG level was 4.6 miu/mL at the post-operative 27th day visit and normal echotecture of the uterus was noted. Menstruation resumed three days after that visit and there has been no subsequent abnormal uterine bleeding within the three months of follow up period.

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Section: Discussionmentioning

confidence: 99%

Caesarean scar pregnancy successfully treated by operative hysteroscopy and suction curettage

Wang

Yuen

Chao

et al. 2005

BJOG

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“…22 Predisposing factors for placenta previa include previous cesarean section, previous cavitary surgery, previous vigorous curettage, multiparity, and advanced maternal age. 19,23,24 Serial evaluation demonstrates placental migration 25 and it is possible to predict which cases will persist to term. 7,9,14,22,[26][27][28] A review of these studies indicates that placentas that overlap the cervix by a distance greater than 10 to 15 mm in the second trimester are likely to be persistently low at term.…”

Section: Placenta Previamentioning

confidence: 99%

Placenta and Transvaginal Sonography

Khurana¹

2018

Donald School Journal of Ultrasound in Obstetrics and Gynecology

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In recent years, transvaginal evaluation of the placenta has completely changed the way obstetricians need to perceive and assess a low-lying placenta. Additionally, the number of negative ultrasound examinations in morbid placental adherence has reduced. This article presents the evidence on the safety and accuracy of transvaginal placental evaluation and goes on to discuss the manner in which transvaginal findings should alter clinical protocols to optimize maternal and fetal outcomes. It also answers a very pertinent clinical question: How low is low?

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“…22 Predisposing factors for placenta previa include previous cesarean section, previous cavitary surgery, previous vigorous curettage, multiparity, and advanced maternal age. 19,23,24 Serial evaluation demonstrates placental migration 25 and it is possible to predict which cases will persist to term. 9,7,14,22,26-28 A review of these studies indicates that placentas that overlap the cervix by a distance greater than 10 to 15 mm in the second trimester are likely to be persistently low at term.…”

Section: Placenta Previamentioning

confidence: 99%

Placenta and Transvaginal Sonography

2015

Donald School Journal of Ultrasound in Obstetrics and Gynecology

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Uncommon Type of Placentation After Previous Cesarean Deliveries

Cited by 7 publications

References 3 publications

Caesarean scar pregnancy successfully treated by operative hysteroscopy and suction curettage

Caesarean scar pregnancy successfully treated by operative hysteroscopy and suction curettage

Placenta and Transvaginal Sonography

Placenta and Transvaginal Sonography

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