ABSTRACT
We present a case series of four patients with Caesarean scar pregnancies (CSPs) managed at our gynaecological unit between October 2008 and May 2009. Three patients were detected while asymptomatic, and were treated with elective intragestational sac methotrexate injections. The last patient had presented following complications from a termination of pregnancy for a CSP that was misdiagnosed as intrauterine. Following treatment, this patient and another developed arteriovenous malformation, which responded to bilateral uterine artery embolisations and gonadotropin releasing hormone (GnRH)-agonist treatment.
Subject(s)
Adult , Female , Humans , Pregnancy , Abortion, Induced , Methods , Cesarean Section , Cicatrix , Magnetic Resonance Imaging , Pregnancy, Ectopic , Diagnosis , Therapeutics , Treatment OutcomeABSTRACT
<p><b>INTRODUCTION</b>Pathologically adherent placentas occur when there is a defect of the decidua basalis, typically arising from previous caesarean section, resulting in abnormally invasive implantation of the placenta. The depth of placental invasion varies from the superficial (accreta), to transmural and possibly beyond (percreta).</p><p><b>CLINICAL PICTURE</b>We report on 2 cases, one treated "conservatively", the other with a caesarean hysterectomy, both of which led to a safe outcome for both mother and baby.</p><p><b>CONCLUSIONS</b>Management relies on accurate early diagnosis with appropriate perioperative multidisciplinary planning to anticipate and avoid massive obstetric haemorrhage at delivery.</p>