Caesarean scar pregnancy: A review of management options

Current Opinion in Obstetrics and Gynecology

Volumn 25, Issue 6, 2013, Pages 456-461

  Litwicka, Katarzyna ^a   Greco, Ermanno ^a  

^a EUROPEAN HOSPITAL   (Italy)

Author keywords

caesarean scar pregnancy; ectopic pregnancy; scar pregnancy treatment

Indexed keywords

CHORIONIC GONADOTROPIN; CHORIONIC GONADOTROPIN BETA SUBUNIT; METHOTREXATE; POLYVINYL ALCOHOL; POTASSIUM CHLORIDE;

ALOPECIA; CESAREAN SCAR PREGNANCY; CURETTAGE; DRUG HALF LIFE; EARLY DIAGNOSIS; ECTOPIC PREGNANCY; FEMALE; FEMALE FERTILITY; GESTATIONAL AGE; GESTATIONAL SAC; HORMONE BLOOD LEVEL; HUMAN; HYSTERECTOMY; HYSTEROSCOPY; LAPAROTOMY; LEUKOCYTE DISORDER; LEUKOPENIA; LIVER DYSFUNCTION; NAUSEA; OPERATIVE BLOOD LOSS; PNEUMONIA; PRIORITY JOURNAL; QUALITY OF LIFE; REVIEW; STOMATITIS; TRANSVAGINAL ECHOGRAPHY; UTERINE ARTERY EMBOLIZATION; UTERUS BLEEDING; UTERUS RUPTURE; VAGINA BLEEDING;

ABORTIFACIENT AGENTS, NONSTEROIDAL; ABORTION, THERAPEUTIC; CESAREAN SECTION; CICATRIX; CURETTAGE; FEMALE; FERTILITY; HUMANS; HYSTEROSCOPY; LAPAROSCOPY; LAPAROTOMY; METHOTREXATE; PREGNANCY; PREGNANCY, ECTOPIC; QUALITY OF LIFE; UTERINE HEMORRHAGE;

EID: 84888133374     PISSN: 1040872X     EISSN: 1473656X     Source Type: Journal    
DOI: 10.1097/GCO.0000000000000023     Document Type: Review

References (76)

1. Maymon R, Halperin R, Mendlovic S, et al. Ectopic pregnancies in a caesarean scar: review of the medical approach to an iatrogenic complication. Hum Reprod Update 2004; 10:515-523.
2. Ash A, Smith A, Maxwell D. Caesarean scar pregnancy. BJOG 2007; 114:253-263.
3. Rotas M, Haberman S, Levgur M. Cesarean scar ectopic pregnancies. Obstet Gynecol 2006; 107:1373-1381.
4. Sadeghi H, Rutherford T, Rackow B, et al. Cesarean scar ectopic pregnancy: case series and review of the literature. Am J Perinatol 2010; 27:111-120.
5. Jurkovic D, Hillaby K, Woelfer B, et al. First-trimester diagnosis and management of pregnancies implanted into the lower uterine caesarean section scar. Ultrasound Obstet Gynecol 2003; 21:220-227.
6. Seow KM, Huang LW, Lin YH, et al. Caesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol 2004; 23:247-253.
7. Yela AA, Marchiani N. Conservative management of ectopic pregnancy in cesarean scar: case report. Rev Bras Ginecol Obstet 2013; 35:233-237.
8. Shen L, Tan A, Zhu H, et al. Bilateral uterine artery chemoembolization with methotrexate for cesarean scar pregnancy. Am J Obstet Gynecol 2012; 207:386.e1-386.e6.
9. Tan G, Chong Y, Biswas A. Caesarean scar pregnancy: a diagnosis to consider carefully in patients with risk factors. Ann Acad Singapore 2005; 34:216-219.
10. Shao HJ, Ma JT, Xu LP, et al. Comprehensive analysis of therapeutic methods and effect on cesarean scar pregnancy. Zhonghua Yi Xue Za Zhi 2012; 92:2191-2194.
11. Shao MJ, Hu M, Hu MX. Conservative management of cesarean scar pregnancy by local injection of ethanol under hysteroscopic guidance. Int J Gynaecol Obstet 2013; 121:281-282.
12. Jain S, Suneja A, Malik R, et al. Cesarean scar pregnancy: a diagnostic dilemma and impending catastrophe. Arch Gynecol Obstet 2013. [Epub ahead of print]
13. Uysal F, Uysal A, Adam G. Cesarean scar pregnancy: diagnosis, management, and follow-up. J Ultrasound Med 2013; 32:1295-1300.
14. Litwicka K, Greco E. Caesarean scar pregnancy: a review of management options. Curr Opin Obstet Gynecol 2011; 23:415-421.
15. Timor-Tritsch IE, Monteagudo A, Santos R, et al. The diagnosis, treatment, and follow-up of cesarean scar pregnancy. Am J Obstet Gynecol 2012; 207:44.e1-44.e13.
16. Le A, Shan L, Xiao T, et al. Transvaginal surgical treatment of cesarean scar ectopic pregnancy. Arch Gynecol Obstet 2013; 287:791-796.
17. 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; 161:75-79.
18. Lu HY, Zhang WH, Shan J, et al. Study on 31 cases with cesarean scar pregnancy treated by transvaginal surgery. Zhonghua Fu Chan Ke Za Zhi 2011; 46:917-922.
19. Vial Y, Petignat P, Hohlfeld P. Pregnancy in a caesarean scar. Ultrasound Obstet Gynecol 2000; 16:592-593.
20. Hong SC, Lau MS, Yam PK. Ectopic pregnancy in previous caesarean section scar. Singapore Med J 2011; 52:e115-e117.
21. Herman A, Weinraub Z, Avrech O, et al. Follow-up and outcome of isthmic pregnancy located in a previous caesarean section scar. BJOG 1995; 102:839-841.
22. Bai XX, Gao HJ, Yang XF, et al. Expectant management of heterotopic cesarean scar pregnancy. Chin Med J 2012; 125:1341-1344.
23. Smith A, Maxwell D, Ash A. Sonographic diagnosis of caesarean scar pregnancy at 16 weeks. J Clin Ultrasound 2007; 35:212-215.
24. Liu H, Leng J, Shi H, Lang J. Expectant treatment of caesarean scar pregnancy: two cases reports and a glimpse at the natural courses. Arch Gynecol Obstet 2010; 282:455-458.
25. Ghezzi F, Lagana D, Franchi M, et al. Conservative treatment by chemotherapy and uterine artery embolization of a cesarean scar pregnancy. Eur J Obstet Gynecol Reprod Biol 2002; 103:88-91.
26. Shufaro Y, Nadjari M. Implantation of a gestational sac in a cesarean section scar. Fertile Steril 2001; 75:1217.
27. Ravhon A, Ben-Chetrit A, Rabinowitz R, et al. Successful methotrexate treatment of a viable pregnancy in a thin uterine scar. Br J Obstet Gynaecol 1997; 104:628-629.
28. Hwu YM, Hsu CY, Yang HY. Conservative treatment of caesarean scar pregnancy with transvaginal needle aspiration of the embryo. BJOG 2005; 112:841-842.
29. Graesslin O, Dedecker F, Quereux C, et al. Conservative treatment of ectopic pregnancy in a cesarean scar. Obstet Gynecol 2005; 105:869-871.
30. Imbar T, Bloom A, Ushakov F, et al. Uterine artery embolization to control haemorrhage after termination of pregnancy implanted in a caesarean delivery scar. J Ultrasound Med 2003; 22:1111-1115.
31. Marchiole P, Gorlero F, de Caro G, et al. Intramural pregnancy embedded in a previous cesarean section scar treated conservatively. Ultrasound Obstet Gynecol 2004; 23:307-309.
32. Li N, Zhu F, Fu S, et al. Transvaginal ultrasound-guided embryo aspiration plus local administration of low-dose methotrexate for caesarean scar pregnancy. Ultrasound Med Biol 2012; 38:209-213.
33. Lian F, Wang Y, Chen W, et al. Uterine artery embolization combined with local methotrexate and systemic methotrexate for treatment of caesarean scar pregnancy with different ultrasonographic pattern. Cardiovasc Intervent Radiol 2012; 35:286-291.
34. Flystra DL, Pound-Chang T, Miller MG, et al. Ectopic pregnancy within a caesarean delivery scar: a case report. Am J Obstet Gynecol 2002; 187:302-304.
35. Fylstra DL. Ectopic pregnancy within a caesarean scar: a review. Obstet Gynecol Surv 2002; 57:537-543.
36. Hasewaga J, Izuka K, Matsuoka R, et al. Limitations of conservative treatment for repeat caesarean scar pregnancy. Ultrasound Obstet Gynecol 2005; 25:310-311.
37. Brasic N, Warden M, Vargas JE. Conservative management of cesarean scar pregnancy with sonographically guided transvaginal methotrexate injection. J Ultrasound Med 2013; 32:1061-1063.
38. Frishman GN, Melzer KE, Bhagavath B. Ectopic pregnancy in a cesareansection scar: the patient 6 weeks into an ectopic pregnancy, underwent local treatment. Am J Obstet Gynecol 2012; 207:238.e1-238.e2.
39. Wang J, Xu K, Lin J, et al. Methotrexate therapy for caesarean section scar pregnancy with or without suction curettage. Fertile Steril 2009; 92:1208-1213.
40. Stevens EE, Ogburn P. Cesarean scar ectopic pregnancy: a case report of failed combination local and systemic methotrexate management requiring surgical intervention. J Reprod Med 2011; 56:356-358.
41. Seow KM, Wang PH, Huang LW, et al. Transvaginal sono-guided aspiration of gestational sac concurrent with a local methotrexate injection for the treatment of unruptured cesarean scar pregnancy. Arch Gynecol Obstet 2013; 288:361-366.
42. Wang CJ, Yuen LT, Chao AS, et al. Caesarean scar pregnancy successfully treated by operative hysteroscopy and suction curettage. BJOG 2005; 112:839-840.
43. Wang YL, Su TH, Chen HS. Laparoscopic management of an ectopic pregnancy in a lower segment of caesarean scar: a review and case report. J Minim Inv Gynecol 2005; 12:73-79.
44. Wang CJ, Yuen LT, Yen CF, et al. Three-dimensional power Doppler ultrasound diagnosis and laparoscopic management of a pregnancy in a previous caesarean scar. J Laparoendosc Adv Surg Tech A 2004; 14:399-402.
45. Wang YL, Su TH, Chen HS. Operative laparoscopy for unruptured ectopic pregnancy in a caesarean scar pregnancy. BJOG 2006; 113:1035-1038.
46. Wang CJ, Chao AS, Yuen LT, et al. Endoscopic management of caesarean scar pregnancy. Fertil Steril 2006; 85:494-497.
47. Wang C, Tseng C. Primary evacuation therapy for cesarean scar pregnancy: three new cases and review. Ultrasound Obstet Gynecol 2006; 27:222-226.
48. Deans R, Abbot J. Hysteroscopic management of cesarean scar ectopic pregnancy. Fertile Steril 2010; 93:1735-1740.
49. Robinson J, Dayal M, Gindoff P, Frankfurter D. A novel surgical treatment for caesarean scar pregnancy: laparoscopically assisted operative hysteroscopy. Fertil Steril 2009; 92:1497.e13-1497.e16.
50. Chao A, Wang TH, Wang CJ, et al. Hysteroscopic management of caesarean scar pregnancy after unsuccessful methotrexate treatment. J Minim Invasive Gynecol 2005; 12:374-376.
51. Chang Y, Kay N, Chen Y, et al. Resectoscopic treatment of ectopic pregnancy in previous caesarean delivery scar defect with vasopressin injection. Fertil Steril 2011; 96:e80-e82.
52. Lee CL, Wang CJ, Chao A, et al. Laparoscoic management of an ectopic pregnancy in a previous caesarean section scar.HumReprod 1999; 14:1234-1236.
53. Li H, Guo H, Han J, et al. Endoscopic treatment of ectopic pregnancy in a cesarean scar. J Minim invasive Gynecol 2011; 18:31-35.
54. Spycha?a P, Nowakowski B. Laparoscopic management of an ectopic pregnancy in a previous caesarean section scar. Ginekol Pol 2012; 83:622-625.
55. Zhang Y, Duan H, Cheng JM, et al. Treatment options to terminate persistent cesarean scar pregnancy. Gynecol Obstet Invest 2013; 75:115-119.
56. Chen C, Wang P, Liu W. Successful treatment of caesarean scar pregnancy using laparoscopically assisted local injection of etoposide with transvaginal ultrasound guidance. Fertil Steril 2009; 92:1747.e9-1747.e11.
57. Shih J. Cesarean scar pregnancy: diagnosis with three-dimensional (3D) ultrasound and3DpowerDoppler ultrasound.Obstet Gynecol2004; 23:306-307.
58. Valley MT, Pierce JG, Daniel TB, Kaunitz AM. Cesarean scar pregnancy: imaging and treatment with a conservative surgery. Obstet Gynecol 1998; 91:838-840.
59. Seow KM, Hwang JL, Tsai YL. Ultrasound diagnosis of a pregnancy in a caesarean section scar. Ultrasound Obstet Gynecol 2001; 18:547-549.
60. Lam PM, Lo KWK, Lau TK. Unsuccessful medical treatment of cesarean scar ectopic pregnancy with methotrexate: a case report of two cases. Acta Obstet Gynecol Scand 2004; 83:108-116.
61. Zhang Y, Gu Y, Wang JM, Li Y. Analysis of cases with cesarean scar pregnancy. J Obstet Gynaecol Res 2013; 39:195-202.
62. Takeda A, Koyama K, Imoto S, et al. Diagnostic multimodal imaging and therapeutic transcatheter arterial chembolization with Dactinomicyn for conservative management of hemorrhagic caesarean scar pregnancy. Eur J Obstet Gynecol Reprod Biol 2010; 152:152-156.
63. Kang S, Park B, Kim Y, Ro D. Surgical management of caesarean scar ectopic pregnancy: hysterectomy by transvaginal approach. Fertil Steril 2011; 96:e25-e28.
64. He M, Chen MH, Xie HZ, et al. Transvaginal removal of ectopic pregnancy tissue and repair of uterine defect for caesarean scar pregnancy. BJOG 2011; 118:1136-1139.
65. Arslan M, Pata O, Dilek TU, et al. Treatment of viable caesarean scar ectopic pregnancy with suction curettage. Int J Gynecol Obstet 2005; 89:163-166.
66. Liang F, He J. Methotrexate-based bilateral uterine arterial chemoembolization for treatment of caesarean scar pregnancy. Acta Obstet Gynecol Scand 2010; 89:1592-1594.
67. Padovan P, Lauri F, Marchetti M. Intrauterine ectopic pregnancy: a case report. Clin Exp Obstet Gynecol 1998; 25:79-80.
68. Li SP, Wang W, Tang XL, Wang Y. Cesarean scar pregnancy: a case report. Chin Med J 2004; 117:316-317.
69. Neiger R, Weldon K, Means N. Intramural pregnancy in a caesarean section scar: a case report. J Reprod Med 1998; 43:999-1001.
70. Chiang A, La V, Chou C, et al. Ectopic pregnancy in a caesarean section scar. Fertil Steril 2011; 95:2388-2389.
71. Yang MJ, Jeng MH. Combination of transarterial embolization of uterine arteries and conservative surgical treatment for pregnancy in a caesarean section scar: a report of 3 cases. J Reprod Med 2003; 48:213-216.
72. Yang XY, Yu H, Li KM, et al. Uterine artery embolization combined with local methotrexate for treatment of caesarean scar pregnancy. BJOG 2010; 117:990-996.
73. Pyra K, Woźniak S, Szkodziak P, et al. Uterine artery embolisation in massive vaginal bleeding in ectopic pregnancy: case report. Przegl Lek 2012; 69:399-401.
74. de Vaate A, Brolmann H, van der Slikke J, et al. Therapeutic options of caesarean scar pregnancy: case series and literature review. J Clin Ultrasound 2010; 38:75-84.
75. Hois E, Hibbeln J, Alonzo M, et al. Ectopic pregnancy in a caesarean section treated with intramuscular methotrexate and bilateral uterine artery embolization. J Clin Ultrasound 2008; 36:123-127.
76. Li C, Li C, Feng D, et al. Transcatheter arterial chemoembolization versus systemic methotrexate for the management of cesarean scar pregnancy. Int J Gynaecol Obstet 2011; 113:178-182.