Ultrasound guided vacuum aspiration treatment of caesarean scar ectopic pregnancy
Authors:
Totka Adrián; Gábor Martin; Alföldi Martin; Kunochová Ivana; Ferianec Vladimír
Authors‘ workplace:
II. gynekologicko-pôrodnícka klinika LF UK a UN Bratislava, Slovenská republika
Published in:
Ceska Gynekol 2021; 86(3): 184-188
Category:
Case Report
doi:
https://doi.org/10.48095/cccg2021184
Overview
Objective: To describe the case of ectopic pregnancy in the scar after caesarean section and its successful treatment using the technique of sonographically controlled vacuum aspiration.
Case report: The case of a 35-year-old patient with a history of two caesarean sections referred by a district gynecologist in the 6th week of pregnancy with suspected pathological localization of pregnancy in a scar after a previous caesarean section. The procedure for the diagnosis and treatment of ectopic pregnancy in the scar after previous caesarean sections has been successfully resolved using sonographically controlled vaginal vacuum aspiration.
Conclusion: Caesarean scar pregnancy occurs as a complication of previous caesarean section or other uterine instrumental performances. The use of the sonographically controlled vacuum aspiration technique appears to be a successful method of treating pregnancy in a scar after a caesarean section.
Keywords:
caesarean scar pregnancy – ectopic pregnancy – suction curettage – ultrasonography
Sources
1. Jurkovic D, Knez J, Appiah A et al. Surgical treatment of Cesarean scar ectopic pregnancy: efficacy and safety of ultrasound‐guided suction curettage. Ultrasound Obstet Gynecol 2016; 47 (4): 511–517. doi: 10.1002/uog.15857.
2. Sel G, Sucu S, Harma M et al. Successful management of cesarean scar pregnancy with vacuum extraction under ultrasound guidance. Acute Med Surg 2018; 5 (4): 358–361. doi: 10.1002/ams2.362.
3. Seow KM, Huang LW, Lin YH et al. Cesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol 2004; 23 (3): 247–253. doi: 10.1002/uog.974.
4. Wang M, Yang Z, Li Y et al. Conservative management of cesarean scar pregnancies: a prospective randomized controlled trial at a single center. Int J Clin Exp Med 2015; 8 (10): 18972–18980.
5. Yin XH, Yang SZ, Wang ZQ et al. Injection of MTX for the treatment of cesarean scar pregnancy: comparison between different methods. Int J Clin Exp Med 2014; 7 (7): 1867–1872.
6. Zhuang YL, Huang LL. Uterine artery embolization compared with methotrexate for the management of pregnancy implanted within a cesarean scar. Am J Obstet Gynecol 2009; 201 (2): 152.e1–e3. doi: 10.1016/j.ajog.2009.04.038.
7. Karásek V. Gravidita v jizvě po císařském řezu – kazuistika. Ceska Gynekol 2015; 80 (5): 382–385.
8. Wang CJ, Chao AS, Yuen LT et al. Endoscopic management of cesarean scar pregnancy. Fertil Steril 2006; 85 (2): 494.e1–e4. doi: 10.1016/j.fertnstert.2005.07.1322.
9. Larsen JV, Solomon MH. Pregnancy in a uterine scar sacculus: an unusual cause of postabortal haemorrhage. A case report. S Afr Med J 1978; 53 (4): 142–143.
10. Vial Y, Petignat P, Hohlfeld P. Pregnancy in a cesarean scar. Ultrasound Obstet Gynecol 2000; 16 (6): 592–593. doi: 10.1046/j.1469-0705. 2000.00300-2.x.
11. Lee CL, Wang CJ, Chao A et al. Laparoscopic management of an ectopic pregnancy in a previous Caesarean section car. Hum Reprod 1999; 14 (5): 1234–1236. doi: 10.1093/humrep/ 14.5.1234.
12. Valley MT, Pierce JG, Daniel TB et al. Cesarean scar pregnancy: imaging and treatment with conservative surgery. Obstet Gynecol 1998; 91 (5 Pt 2): 838–840. doi: 10.1016/s0029- 7844 (97) 00426-2.
13. Miller R, Timor-Tritsch IE, Gyamfi-Bannerman C. Society for Maternal-Fetal Medicine (SMFM) consult series #49: Cesarean scar pregnancy. Am J Obstet Gynecol 2020; 222 (5): B2–B14. doi: 10.1016/j.ajog.2020.01.030.
14. Timor-Tritsch IE, Monteagudo A, Santos R et al. The diagnosis, treatment, and follow-up of cesarean scar pregnancy. Am J Obstet Gynecol 2012; 207 (1): 44.e1–e13. doi: 10.1016/j.ajog.2012.04.018.
15. Bielik T, Bornay I, Rosová L. Ektopická gravidita v jazve po cisárskom reze úspešne riešená kyretážou a operačnou hysteroskopiou. Slov Gynek Pôrod 2013; 20: 38–42.
16. Marcus S, Cheng E, Goff B. Extrauterine pregnancy resulting from early uterine rupture. Obstet Gynecol 1999; 94 (5 Pt 2): 804–805. doi: 10.1016/s0029-7844 (99) 00492-5.
17. Pascual MA, Hereter L, Graupera B et al. Three dimensional power Doppler ultrasound diagnosis and conservative treatment of ectopic pregnancy in a cesarean section scar. Fertil Steril 2007; 88 (3): 706.e5–e7. doi: 10.1016/j.fertnstert. 2006.11.183.
18. Wang M, Chen B, Wang J et al. Nonsurgical management of live tubal ectopic pregnancy by ultrasound-guided local injection and systemic methotrexate. J Minim Invasive Gynecol 2014; 21 (4): 642–649. doi: 10.1016/j.jmig.2014.01.009.
19. Kalampokas E, Boutas I, Panoulis K et al. Novel medical therapy of Cesarean scar pregnancy with a viable embryo combining multidose methotrexate and mifepristone: a case report. Medicine (Baltimore) 2015; 94 (41): e1697. doi: 10.1097/MD.0000000000001697.
20. Arslan M, Pata O, Dilek TU et al. Treatment of viable cesarean scar ectopic pregnancy with suction curettage. Int J Gynaecol Obstet 2005; 89 (2): 163–166. doi: 10.1016/j.ijgo.2004.12.038.
21. Ash A, Smith A, Maxwell D. Caesarean scar pregnancy. BJOG 2007; 114 (3): 253–263. doi: 10.1111/j.1471-0528.2006.01237.x.
22. Vo TM, Van T, Nguyen L et al. Management of cesarean scar pregnancy among Vietnamese women. Gynecol Minim Invasive Ther 2019; 8 (1): 12–18. doi: 10.4103/GMIT.GMIT_8_18.
23. Wang H, Garmel S. Successful term pregnancy after bilateral uterine artery embolization for postpartum hemorrhage. Obstet Gynecol 2003; 102 (3): 603–604. doi: 10.1016/s0029-7844 (03) 00230-8.
24. Cao S, Zhu L, Jin L, et al. Uterine artery embolization in cesarean scar pregnancy: safe and effective intervention. Chin Med J (Engl) 2014; 127 (12): 2322–2326.
25. Gao L, Huang Z, Gao J et al. Uterine artery embolization followed by dilation and curettage within 24 hours compared with systemic methotrexate for cesarean scar pregnancy. Int J Gynaecol Obstet 2014; 127 (2): 147–151. doi: 10.1016/j.ijgo.2014.05.005.
26. Qian ZD, Huang LL, Zhu XM. Curettage or operative hysteroscopy in the treatment of cesarean scar pregnancy. Arch Gynecol Obstet 2015; 292 (5): 1055–1061. doi: 10.1007/s00404- 015-3730-1.
27. Wu X, Zhang X, Zhu J et al. Caesarean scar pregnancy: comparative efficacy and safety of treatment by uterine artery chemoembolization and systemic methotrexate injection. Eur J Obstet Gynecol Reprod Biol 2012; 161 (1): 75–79. doi: 10.1016/j.ejogrb.2011.11.026.
28. Wang YK, Xu B, Dai SZ et al. An efficient conservative treatment modality for cervical pregnancy: angiographic uterine artery embolization followed by immediate curettage. Am J Obstet Gynecol 2011; 204 (1): 31.e1–e7. doi: 10.1016/j.ajog.2010.08.048.
29. Jiménez-Caraballo A, Rodríguez-Donoso G. A 6-year clinical trial of methotrexate therapy in the treatment of ectopic pregnancy. Eur J Obstet Gynecol Reprod Biol 1998; 79 (2): 167–171. doi: 10.1016/s0301-2115 (98) 00 036-0.
30. W LH, Z YL, H LL. Clinical analyses of seventy pregnancies within caesarean scar. Chin J Obstet Gynecol 2007; 42: 487–488.
31. Hudeček R, Felsingerová Z, Felsinger M et al. Laparoscopic treatment of Cesarean scar ectopic pregnancy. J Gynecol Surg 2014; 30 (5): 309–311. doi: 10.1089/gyn.2014.0005.
Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicineArticle was published in
Czech Gynaecology
![Issue 3](https://www.prolekare.cz/media/cache/resolve/journal_issue/media/image_pdf/6fa95ac2aa3523fe4e946ad03c0b35b5.jpeg)
2021 Issue 3
Most read in this issue
- Estetrol and the possibilities of its clinical use
- Adenomyosis – its possible effect on endometrial function and receptivity
- Hereditary antithrombin deficiency in pregnancy – severe thrombophilic disorder as a danger for mother and foetus
- Changes of the quality of sexual life following pelvic organ prolapse surgery