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Transvaginal ultrasound showing cesarean scar ectopic pregnancy at 6 weeks and 3 days.
Source publication
Cesarean scar pregnancy (CSP) is a very serious complication of a prior cesarean delivery. The major risks associated with CSP are uncontrolled hemorrhage and uterine rupture, potentially leading to future infertility. Management of CSP remains a major obstetric challenge without a well-defined therapeutic procedure. Dilation & curettage is a commo...
Context in source publication
Context 1
... the patient's initial presentation, lab studies revealed her beta-human chorionic gonadotropin (HCG) levels to be 49,429 mIU/mL. The patient underwent a transvaginal and transabdominal ultrasound, which showed a cesarean scar pregnancy with a present cardiac activity of 101 BPM in a single gestational sac located in the mid-uterus (Figure 1). Crown rump length was found to be 3.8 mm. ...
Citations
... Ectopic pregnancies account for about 1-2% of total pregnancies [1,2]. A cesarean scar pregnancy is a rare form of ectopic pregnancy defined as the implantation of the pregnancy into the myometrial defect of the previous uterine scar [3]. ...
... A cesarean scar pregnancy is a rare form of ectopic pregnancy defined as the implantation of the pregnancy into the myometrial defect of the previous uterine scar [3]. The incidence of cesarean scar pregnancy (CSP) ranges from 1/800 to 1/2500 pregnancies [2,4] and appears to be increasing with increasing rates of CS in the United States [1,5]. Proper diagnosis and management of CSP are highly important to avoid uterine rupture and life-threatening hemorrhage. ...
... Type III grows toward the abdominal cavity/uterine serosa and is associated with deeper implantation and early uterine rupture [4,6]. Vaginal bleeding and abdominal pain are common presenting symptoms of CSP [1,2]. However, up to 1/3rd of patients with CSP may be asymptomatic and are diagnosed when they present for routine prenatal ultrasound [6]. ...
... Daram et al reported a case in which Myosure device was used as a successful treatment for removing products of conception of caesarean scar ectopic pregnancy [39].Keriakos R et al also used Myosure for the management of cornual ectopic pregnancy [40]. ...
... Ectopic pregnancies caused by cesarean delivery are more likely to occur in women who have had one before. For the mother, these pregnancies can be potentially fatal consequences [33]. ...
Massive pulmonary embolism (PE) is an uncommon but severe complication of pregnancy or during the first few weeks after giving birth. Our intention was to thoroughly analyze the information available to its management methods. Significant bleeding of mother survival and early deliveries in fetal survivals were having hemorrhage and were having key outcomes. We found 127 severe PE cases that have had at least one form of treatment (at least 83% big; 23% with cardiac arrest). The 83 women who received thrombolysis had a 94% (95%) survival rate. Cardiac arrest in pregnancy is uncommon, although maintaining current competency can be challenging. While maternal mortality rates have decreased globally over the past 25 years, they have increased in the United States. The intricacy of the maternal mortality issue is a result of a number of clinical and socioeconomic problems such as unequal healthcare access, racial and ethnic disparities, maternal comorbidities, and bias in epidemiologic ascertainment. The importance of doctors being prepared to react to a potential maternal cardiac arrest in any situation where they are providing treatment for pregnant women is highlighted by the rise in maternal mortality. For the treatment of maternal cardiac arrest, an interdisciplinary team with expertise in both the maternal resuscitation procedure and the physiological changes that take place during pregnancy is necessary. Additionally offered are basic and advanced cardiac life support protocols. Techniques to remove obstacles like aortocaval compression that could impair the effectiveness of resuscitation should be used.
Purpose of review:
Nontubal ectopic pregnancies appear to be increasing in prevalence. Increasingly, minimally invasive methods for management are being utilized. A current literature review and recommendations for management of nontubal ectopic pregnancy is presented in this review.
Recent findings:
Nontubal ectopic pregnancies are less common than tubal ectopic pregnancies but present a unique and significant threat to patient's health and are optimally managed by specialists familiar with the condition. Early diagnosis, prompt treatment and close follow-up to resolution are critical. Recent publications focus on fertility-sparing and conservative management through the use of medications both systemic and local; as well as minimally invasive surgical techniques. The Society of Maternal Fetal Medicine recommends against expectant management of cesarean scar pregnancies; however, optimal treatment is unknown and this holds true for management of other nontubal ectopic pregnancies.
Summary:
Minimally invasive and fertility sparing management should be the mainstay in treatment of stable patients with nontubal ectopic pregnancy.
