Abstract
Cesarean scar implantation represents a rare, though growing subset of potentially life-threatening ectopic pregnancy. Because of the global increase in cesarean sections as well as the improved diagnostic abilities of transvaginal ultrasound, incidence rates have continued to rise since the first reported case in 1978. Uterine rupture and catastrophic hemorrhage can ensue when diagnosis is delayed. Additionally, a higher rate of concurrent trophoblastic myometrial invasion may increase the incidence of retained products of conception or post procedural bleeding. Endovaginal ultrasound has a reported sensitivity of 85 % for detection. In difficult cases, magnetic resonance imaging is often useful as a problem solving exam in confirming diagnostic suspicions and guiding therapeutic decisions. We present a series of five illustrative cases illustrating the range of clinical and imaging findings.
Sommario
La cicatrice da taglio cesareo rappresenta nella gravidanza ectopica una rara seppur crescente concausa potenzialmente pericolosa per la vita. L’aumento su scala globale della pratica del taglio cesareo, nonostante il supporto dell’applicazione dell’ecografia trans-vaginale sempre più precisa, ha visto crescere i tassi di incidenza a partire dal primo caso riportato nel 1978. Quando la diagnosi è tardiva ne può derivare la rottura dell’utero con conseguente grave emorragia. Inoltre, il verificarsi concomitante di invasione trofoblastica a livello del miometrio potrebbe aumentare l’incidenza dei residui da concepimento o delle emorragie post intervento. L’ecografia trans vaginale ha una capacità diagnostica dell’85 %. Nei casi più difficili, la RM è spesso utile come esame risolutore nel confermare i sospetti diagnostici e guidare quindi verso la terapia appropriata. Vi presentiamo 5 casi esemplificativi che illustrano la varietà di dati clinici ed imaging.
References
Ash A, Smith A, Maxwell D (2007) Caesarean scar pregnancy. BJOG 114(3):253–263
Maymon R, Halpern R, Mendlovik S et al (2004) Ectopic pregnancies caesarean section scars: the 8 year experience of one medical centre. Hum Reprod 19(2):278–284
Maymon R, Halpern R, Mendlovik S et al (2004) Ectopic pregnancies in a ceasarean scar: review of the medical approach to an iatrogenic complication. Hum Reprod 10(6):515–523
Rotas M, Haberman S, Levgur M (2006) Caesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol 107(6):1373–1381
Vial Y, Petignat P, Hohlfeld P (2000) Pregnancy in a caesarean scar. Ultrasound Obstet Gynecol 16(6):592–593
Wu R, Klein M, Mahboob S, Gupta M et al (2013) Magnetic resonance imaging as an adjunct to ultrasound in evaluating cesarean scar ectopic pregnancy. J Clin Imaging Sci 3:16. doi:10.4103/2156-7514.109758
Fylstra D (2002) Ectopic pregnancy within a cesarean scar: a review. Obstet Gynecol Surv 57:537–543
Lee C, Wang C, Chao A, Yen C (1999) Laparoscopic management of an ectopic pregnancy in a previous caesarean section scar. Hum Reprod 14(5):1234–1236
Graesslin O, Dedecker F, Quereuz C et al (2005) Conservative management of ectopic pregnancy in a cesarean scar. Obstet Gynecol 105(4):869–871
Seow K, Huang L, Lin Y et al (2004) Cesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol 23(3):247–253
Moschos E, Wells C, Twickler D (2014) Biometric sonographic findings of abnormally adherent trophoblastic implantations on cesarean delivery scars. J Ultrasound Med 33(3):475–481
Jurkovic D, Jauniaux E, Kurjak A et al (1991) Transvaginal color doppler assessment of the uteroplacental circulation in early pregnancy. Obstet Gynecol 77:365–369
Yang X, Yu H, Li K et al (2010) Uterine artery embolization combined with local methotrexate for treatment of caesarean scar pregnancy. BJOG 117:990–996
Conflict of interest
The authors, M Rheinboldt, Z Delproposto, and D Osborn, declare that they have no conflicts of interest.
Ethical standard
All data was collected retrospectively in accordance with the laws of the United States for patient confidentiality and current 2015 Health and Insurance Portability and Accountability Act Standards (HIPAA) and also met with 2015 Henry Ford Hospital internal review board ethical standards and compliance and approval.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rheinboldt, M., Osborn, D. & Delproposto, Z. Cesarean section scar ectopic pregnancy: a clinical case series. J Ultrasound 18, 191–195 (2015). https://doi.org/10.1007/s40477-015-0162-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40477-015-0162-5