Cesarean scar pregnancy: issues in management

Wiley - Tập 23 Số 3 - Trang 247-253 - 2004
Kok‐Min Seow1,2,3, L.‐W. Huang2, Y.‐H. Lin2,3, Mike Yan‐Sheng Lin4, Yi‐Ling Tsai2, Jhi‐Jhu Hwang2,5
1Department of Obstetrics and Gynecology, Li Shin Hospital, Pingjen, Taoyuan County, Taiwan
2Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
3School of Medicine, Fu-Jen Catholic University, Hsinchuang, Taipei Hsien, Taiwan
4Department of Obstetrics and Gynecology, Chi-Mei Hospital, Tainan, Taiwan
5Taipei Medical University, Taipei, Taiwan

Tóm tắt

AbstractObjectiveTo evaluate our experience with the diagnosis and treatment of Cesarean scar pregnancy.MethodsDuring a 6‐year period, 12 cases of Cesarean scar pregnancy were diagnosed using transvaginal color Doppler sonography and treated conservatively to preserve fertility. Incidence, gestational age, sonographic findings, β‐human chorionic gonadotropin ( β‐hCG) levels, flow profiles of transvaginal color Doppler ultrasound, and methods of treatment were recorded.ResultsThe incidence of Cesarean scar pregnancy was 1:2216 and its rate was 6.1% in women with an ectopic pregnancy and at least one previous Cesarean section. Gestational age at diagnosis ranged from 5 + 0 to 12 + 4 weeks. The time interval from the last Cesarean section to the diagnosis of Cesarean scar pregnancy ranged from 6 months to 12 years. High‐velocity and low‐impedance subtrophoblastic flow (resistance index, 0.38) persisted until β‐hCG declined to normal. Patients were treated as follows: transvaginal ultrasound‐guided injection of methotrexate into the embryo or gestational sac (n = 3), transabdominal ultrasound‐guided injection of methotrexate (n = 2), transabdominal ultrasound‐guided injection of methotrexate followed by systemic methotrexate administration (n = 2), systemic methotrexate administration alone (n = 2), dilatation and curettage (n = 2), or local resection of the gestation mass (n = 1). Eleven of the 12 patients preserved their reproductive capacity; the remaining patient, treated by dilatation and curettage, underwent a hysterectomy because of profuse vaginal bleeding. The Cesarean scar mass regressed from 2 months to as long as 1 year after treatment. Uterine rupture occurred in one patient during the following pregnancy at 38 + 3 weeks' gestational age.ConclusionUltrasound‐guided methotrexate injection emerges as the treatment of choice to terminate Cesarean scar pregnancy. Surgical or invasive techniques, including dilatation and curettage are not recommended for Cesarean scar pregnancy due to high morbidity and poor prognosis. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.

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Tài liệu tham khảo

10.3109/00016349509024394

10.1111/j.1471-0528.1995.tb10855.x

Larsen JV, 1978, Pregnancy in a uterine scar sacculus: an unusual cause of postabortal hemorrhage, S Afr Med J, 53, 142

10.1016/S0015-0282(97)81930-9

10.1111/j.1471-0528.1997.tb11547.x

10.3109/00016349709047838

10.1016/S0029-7844(97)00426-2

Padovan P, 1998, Intrauterine ectopic pregnancy. A case report, Clin Exp Obstet Gynecol, 25, 79

Neiger R, 1998, Intramural pregnancy in a cesarean section scar: A case report, J Reprod Med, 43, 999

Huang KH, 1998, Pregnancy in a previous cesarean section scar: Case report, Changgeng Yi Xue Za Zhi, 21, 323

10.1093/humrep/14.5.1234

10.1046/j.1469-0705.2000.00300-2.x

Seow KM, 2000, Methotrexate for cesarean scar pregnancy following in vitro fertilization and embryo transfer: A case report, J Reprod Med, 45, 754

10.1016/S0301-2115(01)00365-7

10.1034/j.1600-0412.2001.080005469.x

10.1016/0301-5629(90)90166-A

10.7863/jum.2001.20.10.1105

10.1016/S0196-0644(82)80256-4

Jurkovic D, 1991, Transvaginal color Doppler assessment of the uteroplacental circulation in early pregnancy, Obstet Gynecol, 77, 365

10.1016/S0140-6736(87)91750-8

10.1097/00006254-199007000-00001

10.1016/S0015-0282(16)54923-1

Timor‐Tritsch IE, 1992, Sonographic evaluation of cornual pregnancies treated without surgery, Obstet Gynecol, 79, 1044

10.1016/0002-9378(89)90653-4

10.1097/00003081-199506000-00018

10.1016/S0015-0282(16)59405-9

10.1016/S0015-0282(16)57289-6

10.1093/humrep/15.7.1646

10.1177/004947559702700225

10.1097/00006250-199912000-00015

10.1097/00006250-199903000-00003

Howe RS, 1993, Third trimester uterine rupture following hysteroscopic uterine perforation, Obstet Gynecol, 81, 827

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Wiley

Tập 23 Số 3

247-253

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