Misoprostol and mid trimester termination of pregnancy in patients with two previous scars and more at Elwiya Maternity Teaching Hospital / Misoprostol e interrupção da gravidez no meio do trimestre em pacientes com duas cicatrizes anteriores e mais no Elwiya Maternity Teaching Hospital

Abstract Objectives: to determine efficiency and safety of three misoprostol regimens for 2nd trimester pregnancy termination in individuals with two or more cesarean section scars. Methods: a cross-sectional study included 100 pregnant ladies at 13th-26th weeks gestation with previous two cesarean sections (CSs) who were scheduled for pregnancy termination using misoprostol. Patients were conveniently assigned to 100µg/3h, 200µg/3h or 400 µg/3h regimens. Primary outcome was time to abortion, secondary outcomes were side effect and complications. Results: a significant association was found between number previous CSs and longer time to abortion (p=0.01). A highly significant association was identified between earlier gestational age and longer time to abortion (p<0.001). Lower side effects and complications were associated with 200 µg misoprostol every 3 hours of (p<0.001). Incomplete abortion was the most frequent recorded complication for the successive doses of misoprostol. Conclusions: misoprostol is an effective drug at low doses for pregnancy termination in women with prior two or more caesarean sections. However, its safety needs monitoring of the patient in the hospital to decrease morbidity and mortality behind its use.

Resumo Objetivos: determinar a eficiência e segurança de três regimes de misoprostol para interrupção da gravidez no segundo trimestre em indivíduos com duas ou mais cicatrizes de cesariana. Métodos: um estudo transversal incluiu 100 gestantes entre 13ª e 26ª semanas de gestação com duas cesarianas (CEs) anteriores que foram agendadas para interrupção da gravidez com uso de misoprostol. Os pacientes foram convenientemente designados para regimes de 100 µg/3 horas, 200 µg/3 horas ou 400 µg/3 horas. O desfecho primário foi o tempo para o aborto, os desfechos secundários foram efeitos colaterais e complicações. Resultados: foi encontrada associação significativa entre o número de cesáreas anteriores e o maior tempo até o aborto (p=0,01). Foi identificada associação altamente significativa entre idade gestacional mais precoce e maior tempo para abortar (p<0,001). Menores efeitos colaterais e complicações foram associados com 200 µg de misoprostol a cada 3 horas (p<0,001). O aborto incompleto foi a complicação mais frequente registrada para as doses sucessivas de misoprostol. Conclusões: o misoprostol é um medicamento eficaz em doses baixas para interrupção da gravidez em mulheres com duas ou mais cesarianas anteriores. Porém, sua segurança necessita de monitoramento do paciente no hospital para diminuir a morbimortalidade por trás de seu uso.

Pouch of sorrow: Undiagnosed isthmocele – presenting as secondary infertility of 11 years in a middle age female

In the past decade, the rate of cesarean sections has doubled leading to the more frequent occurrence of cesarean-related complications. Cesarean scar site diverticulum or isthmocele is one such complication that is defined as an outpouching of the anterior uterine wall at the cesarean scar site in continuity with the endometrial cavity, creating a wedge-shaped defect of variable depth. We report a case of a middle-aged female with secondary infertility for the last 11 years with one live issue 12 years back through a cesarean section at term. She had undergone an array of investigations for infertility for the past 5 years. She was diagnosed as having an isthmocele and managed with surgical repair of the defect at our hospital with subsequent assisted conception 8-month post-surgical repair. The importance of diagnosing a cesarean scar diverticulum cannot be understated not only because it is a surgically treatable cause of infertility but also because if such patients conceive, they may land in uterine rupture, placenta accreta, or scar ectopic pregnancy which can complicate into life-threatening situations.

Efficacy of transcatheter uterine artery embolization in scar pregnancy patients of different ages based on random walk model / 中国医师杂志

Objective:To explore the efficacy and safety of cesarean scar pregnancy (CSP) in different ages treated by uterine artery embolization (UAE).Methods:120 patients with CSP admitted to Jiangyin Hospital of Traditional Chinese Medicine from July 2016 to July 2019 were selected as the research objects. They were divided into observation group (≤35 years, 75 cases) and control group (>35 years, 45 cases) according to age. Clinical data of all patients were collected and followed up for 6 months. The clinical observation indicators, surgical efficacy, Visual Analogue Scale (VAS) score, ovarian recovery, postoperative complications and adverse reactions, and quality of life score at 6 months after surgery were compared between the two groups. A random walk model was used to evaluate the improvement of ovarian function in the two groups.Results:In the observation group, the blood loss, operation time, postoperative β-human chorionic gonadotropin (β-HCG) value, β-HCG value turning negative and menstrual recovery time were significantly less than those in the control group (all P<0.05). The total effective rate was above 90% in the two groups, and no significant difference was observed (96.00% vs 91.11%, P>0.05). There was no statistical significance in VAS score of the two groups before surgery, 48 h and 72 h after surgery (all P>0.05), and VAS score of the observation group at 12 h and 24 h after surgery were significantly higher than those of the control group (all P<0.05). The levels of serum follicle stimulating hormone (FSH), estradiol (E 2), testosterone (T) and luteinizing hormone (LH) in observation group were better than those in control group after treatment (all P<0.05). There was no significant difference in the incidence of secondary uterine clearance, massive bleeding, hysterectomy, incision infection, vaginal bleeding and vaginal hematoma between the two groups (all P>0.05), but the total incidence of complications in observation group was significantly lower than that in control group ( P<0.05). Diarrhea, fever, nausea and vomiting, abdominal pain and other adverse reactions were significantly improved after symptomatic treatment, and there was no significant difference in the incidence of adverse reactions between the two groups ( P>0.05). There was no significant difference in the quality of life score 6 months after surgery between the two groups ( P>0.05). The results of random walk model evaluation showed that the improvement coefficients of the observation group were 0.147 6, 0.135 9, 0.180 2 and 0.206 3, while those of the control group were 0.142 2, 0.098 9, 0.152 4 and 0.197 4, respectively. Conclusions:UAE treatment for CSP patients of different ages showed no significant difference in clinical efficacy, and postoperative complications were not easy to occur, and the prognosis was good.

Clinical value of laparoscopic reversible uterine artery occlusion in treatment of cesarean section scar pregnancy / 中华内分泌外科杂志

Objective:To explore the clinical value of laparoscopic reversible uterine artery occlusion in the treatment of cesarean section scar pregnancy.Methods:A total of 112 patients who were hospitalized in our hospital from Sep. 2018 to Jun. 2020 in the First Affiliated Hospital of Bengbu Medical College and diagnosed with type II and type III cesarean section scars were selected. The patients were divided into groups according to the randomization method, the control group ( n=58) and the study group ( n=54) . The control group used uterine artery embolization combined with laparoscopic removal of pregnancy and uterine scar repair, while the study group used laparoscopic reversible uterine artery occlusion, pregnancy removal surgery and uterine scar repair surgery. The clinical treatment effects of the two groups of patients were compared. Results:The intraoperative blood loss of the control group (21.26±9.64) ml was significantly less than that of the study group (75.25±8.25) ml ( P<0.05) ; the treatment success rate of the study group was 98.15% (53/54) , which was significantly higher than the control group 86.21% (50/58) ( P<0.05) ; the time of vaginal bleeding in the study group (7.26±0.94) d, postoperative menstrual regain time (31.25±1.26) d, and hospital stay (3.14±0.25) d were significantly less than those in the control group ( (9.54±0.94) 0.86) d, (47.25±2.15) d, (9.26±0.94) d) ] ( P<0.05) ; 24 h β-hCG level and β-hCG negative time study group [ (1015.11±325.05) IU/L, (14.25±3.21) d] was significantly less than the control group [ (2654.25±284.25) IU/L, (27.16±5.14) d] ( P<0.05) ; there was no difference in the scores of the modified SF-36 scale before treatment between the two groups ( P>0.05) . The modified SF-36 scale score (63.22±4.25) of the study group after treatment was significantly higher than that of the control group (55.25±3.83) ( P<0.05) . Conclusions:Laparoscopic reversible uterine artery occlusion is effective in treating cesarean section scar pregnancy. After treatment, the β-hCG level of the patient is significantly reduced and the quality of life is significantly improved.

Associação entre a técnica de fechamento uterino na cesárea e a istmocele: uma visão global / Association between uterine closure technique after cesarean and isthmocele: an overview

A istmocele (ou "defeito cicatricial de cesariana") é uma alteração anatômica na parede uterina responsável por formar um "nicho", que é visualizado como uma área hipoecoica por histerografia ou por outros métodos de imagem, devido a uma cicatrização inapropriada de uma cesárea anterior. Essa modificação leva a complicações ginecológicas e obstétricas. Este estudo pretendeu analisar, entre os fatores de risco, a relação da istmocele com a técnica de fechamento uterino, comparando a sutura em camada simples com a dupla. Foi realizada uma revisão de literatura por meio de pesquisa bibliográfica em diferentes bases de dados eletrônicos. Foram encontrados 31 artigos, todavia apenas 13 estudos foram incluídos no presente estudo após avaliação criteriosa. A técnica de fechamento uterino é um dos fatores de risco possível de prevenir, sendo que a sutura em camada simples é associada a maior chance de se desenvolver a istmocele. A sutura de camada simples (ancorada) incluindo o endométrio está relacionada a menor espessura miometrial residual, associada a probabilidade de ruptura uterina e a istmocele, que a camada dupla não ancorada com a exclusão do endométrio.(AU)

The isthmocele is an anatomical alteration in the uterine wall responsible for forming a "niche", which is visualized as a hypoechoic area by hysterography or other imaging methods, due to inappropriate healing of a previous cesarean section. This modification leads to gynecological and obstetric complications. This study aimed to analyze among the risk factors the relation of isthmocele and the uterine closure technique comparing the single- and double-layer suture. It was conducted an electronic based search in different electronic databases. The research led to the retrieval of 31 articles; however only 13 studies were included in the present research after careful reading. The uterine closure technique is one of the possible risk factors to be modified; the single-layer suture is associated with a greater chance of developing isthmocele. The locked single-layer suture including the decidua is related to the decreased residual myometrial thickness, associated with the likelihood of uterine rupture and the isthmocele, than the double-layer unlocked excluding the decidua.(AU)

Tratamiento del embarazo ectópico en cicatriz de cesárea: revisión de la literatura a propósito de 3 casos / Treatment of ectopic pregnancy in a cesarean scar: review of the literature regarding 3 cases

INTRODUCCIÓN Y OBJETIVOS: El embarazo en cicatriz de cesárea previa (ECC) es una entidad poco frecuente que puede tener graves consecuencias. Hasta la fecha no existen esquemas estandarizados de tratamiento y su manejo óptimo sigue siendo controvertido. Nuestro objetivo es realizar una revisión de la literatura publicada sobre el manejo del ECC y proponer un algoritmo. También exponemos tres casos de ECC resueltos con diferentes tratamientos en el Hospital Universitario Infanta Elena MÉTODOS: Búsqueda de la literatura en bases de datos utilizando las palabras clave: "embarazo en cicatriz cesárea"," gestación ectópica en cicatriz cesárea", "tratamiento", "manejo". RESULTADOS: Las opciones terapéuticas pueden ser médicas, quirúrgicas o una combinación de ambas. Los tratamientos quirúrgicos tienen altas tasas de éxito, sin embargo, son más invasivos y no están exentos de riesgo. La combinación de tratamientos parece aumentar la tasa de éxito, no obstante, podría implicar un mayor riesgo de efectos secundarios y costes. CONCLUSIONES: El manejo de los ECC debe de ser individualizado, basado en la evidencia científica, en los medios disponibles y la experiencia de los profesionales en los distintos procedimientos, guiándonos por el tipo de ECC y su grado de vascularización e invasión, grosor del miometrio, niveles de beta-hCG, presencia de actividad cardiaca, clínica y estabilidad hemodinámica de la paciente. Deben tenerse en cuenta las circunstancias y patología intercurrente de la mujer, así como su deseo genésico o de preservación del útero.

INTRODUCTION AND OBJECTIVES: Cesarean scar pregnancy (CSP) is a rare entity that can cause serious consequences. Up to now, there are no standardized treatment schemes, and its optimal management remains controversial. Our objetive is to review the literature regarding CSP management and propose an algorithm. We also present three cases of CSP resolved with different treatments at Hospital Universitario Infanta Elena. METHODS: Literature search in databases using the following keywords: pregnancy with cesarean section, ectopic pregnancy with cesarean section, treatment, management. RESULTS: The therapeutic options can be medical, surgical or a combination of both. Surgical treatments have high success rates; however, they are more invasive and are not without risk. The combination of treatments seems to increase the success rate; however, it could imply a higher risk of side effects and costs. CONCLUSIONS: The management of CSP must be individualized; based on scientific evidence, on the means available, and on the experience of the professionals in the different procedures; guided by the type of CSP and its degree of vascularization and invasion, by the thickness of the myometrium, beta-hCG levels, presence of cardiac activity, and by clinical and hemodynamic stability of the patient. The circumstances and intercurrent pathology of the patient must be considered, as well as her desire for future pregnancy or preservation of the uterus.

Evaluation of prognostic value of cesarean section scar pregnancy after uterine arterial chemoembolization with cesarean section by ultrasonography / 中华超声影像学杂志

Objective@#To assess the clinical value of uterine curettage ultrasound in the evaluation of cesarean section scar pregnancy (CSP) after uterine arterial chemoembolization (UAE).@*Methods@#Retrospective analysis were performed in 42 patients who took uterine curettage within 24-48 hours after UAE treatment in the Second Affiliated Hospital of Harbin Medical University from January 2015 to June 2018. The ultrasonic manifestations were graded and classified before UAE. The intraoperative and postoperative complications, time of β-human chorionic gonadotrophin declined to normal limits were evaluated, and the formation of hematoma and hematoma absorption time were followed up by ultrasound.@*Results@#UAE was performed successfully in all patients. The ultrasound-guided scar pregnancy was successfully completed. The uterus was successfully retained in all patients.Among the 42 patients, 18 cases were 3 scores group, and 24 cases were 4 scores group according to the ultrasonic scoring system. Two cases were type Ⅰgroup, 25 cases were type Ⅱ group, and 15 cases were type Ⅲ group according to the ultrasonic classification. The amount of intraoperative complications, postoperative mass formation and absorption time were significantly different between 3 scores group and 4 scores group (P<0.05). No significant differences were found in intraoperative complications, postoperative complications, postoperative mass formation and β-human chorionic gonadotropin (β-hCG) value among different ultrasonic classification groups (P>0.05).@*Conclusions@#Ultrasonography has clinical application value in evaluating the prognosis of CSP treated with UAE. Ultrasonic scoring system can evaluate the efficacy and is helpful for predicting clinical outcome of CSP.

Caesarean scar pregnancy: a case report with review of management options

Cesarean scar pregnancy is a rare but life-threatening complication. It is the abnormal implantation of gestational sac into myometrium and fibrous scar of previous cesarean section. Its incidence is on rising trend due to increase in rate of cesarean section all over the world. A thirty years old second gravida presented at eight weeks of gestation with complaints of bleeding per vaginum and pain lower abdomen. She was diagnosed as a case of cesarean scar pregnancy (CSP) on ultrasonography and confirmation of diagnosis was done on magnetic resonance imaging. Medical management of scar pregnancy was done successfully with combination of mifepristone and methotrexate. Cesarean scar pregnancy could be catastrophic, if not managed well in time. Management includes both surgical and medical options. Treatment has to be individualized depending on patient’s hemodynamic profile, size of gestational sac, desire for future fertility, compliance for follow up and availability of interventional radiology.

Cesarean scar pregnancy: scope for hysteroscopy

Scar ectopic pregnancy also known as cesarean scar pregnancy is a rare form of an extrauterine pregnancy. The blastocyst is implanted at the site of the previous cesarean scar. Most patients remain asymptomatic and are detected on routine ultrasonography imaging. The diagnosis and management of this condition is hence challenging and difficult. A timely ultrasonography in the early weeks of gestation is the key to preventing catastrophic events like uterine perforation and excessive hemorrhage. There is a wide armamentarium of treatment modalities to choose from, however each case must be individualised. Medical management has its own limitations and often patients are required to have a long-term follow-up. We present a case of a cesarean scar pregnancy managed conservatively with systemic methotrexate but subsequently requiring surgical intervention done successfully via hysteroscopy. A repeat ultrasonography done a fortnight later revealed no retained products of conception.

Pregnancy as a ticking bomb: A sonographic review of type II cesarean section scar pregnancy / Philippine Journal of Obstetrics and Gynecology

@#Cesarean section scar pregnancy (CSP) is a pregnancy implanted outside the uterine cavity in the site of a previous cesarean section scar and is considered the rarest form ectopic pregnancy. CSP is a modern phenomenon and has been reported with increasing incidence due to either an increased reporting or increasing cesarean section rate. The true incidence, however, has not been fully determined as some cases will end up in the first trimester and go unreported or undiagnosed. Undiagnosed cesarean scar pregnancy can be fatal due to life threatening hemorrhage as well as uterine rupture due to an abnormally adherent placenta. Accurate diagnosis is important because it enables the clinicians to establish the risk of complications and aid in prompt management. Ultrasonography is often the first step in detecting CSP and MRI should only be used in equivocal cases. The case presented is in a multiparous woman with ultrasound finding of a cesarean scar pregnancy where expectant management was the initial option but because of the outward progression of the CSP, it was terminated. There is no established universal treatment guidelines for CSP and treatment options include expectant, medical, surgical or combinations of these.

A comparative study of the consistency of ultrasound with MRI on the diagnosis of uterine cesarean scar pregnancy / 中国实用妇科与产科杂志

OBJECTIVE: To explore the consistency of ultrasound with MRI on the diagnosis of uterine cesarean scar pregnancy（CSP）.METHODS: Retrospectively analyze the clinical data of 91 patients from January 2012 to June 2018 in Beijing Chaoyang Hospital and Beijing Luhe Hospital.RESULTS: The ultrasonic:77 cases of CSP were clearly diagnosed（84.6%）,12 cases were suspicious for CSP（13.2%）and 2 cases were misdiagnosed（2.2%）.MRI showed that 90 cases of CSP were clearly diagnosed（98.9%）one case was misdiagnosed（1.1%）.Totally 32 cases were found to have yolk sac in ultrasonography,27 cases of them had fetal buds,and 20 cases of them had embryocardia-beats,while MRI could not distinguish the yolk sac from the fetal bud,and was unable to verify the embryocardia-beats.CONCLUSION: Ultrasonography can be used as the basis for screening and classification of CSP,which can help the early detection and the choice of treatment.The MRI images of CSP have certain specificity,which can provide more accurate imaging data for clinical diagnosis and treatment.3.The combination of ultrasound and MRI can significantly reduce the misdiagnosis of CSP.

Effect analysis of the cesarean scar pregnancy with intervention treatment and expectant treatment / 中国实用妇科与产科杂志

OBJECTIVE: To discuss the clinical significance of cesarean scar pregnancy with expectatant treatment.METHODS: Collect 21 cases of CSP between 2012 and 2017 in the Third Affiliated Hospital of Guangzhou Medical University.Group A had 8 cases who were pregnant again after intervention treatment,and group B had 13 cases who insisted on expecting treatment.We summarized clinical indexes of both groups,such as preserving uterus,bladder rupture,admission to ICU,blood transfusion,placenta implantation,etc. in order to further study the significance of expecting treatment for CSP.RESULTS: All of group A were pregnant again after intervention treatment,of whom 1 was CSP again and hysterectomy was performed at 15 weeks due to placenta implantation,while another 7 were uterine pregnancy,of whom 3 were term birth and had no placenta implantation,and another 4 were terminated in response to the requirements of patients,of whom 1 was treated with drug abortion and 3 underwent dilatation and curettage.Uterus was preserved in the 7 women,and there was no bladder rupture,no admission to ICU,no blood transfusion,and no placenta implantation.Among the 13 cases in group B, 6 cases underwent cesarean section during third trimester,including 3 cases of premature delivery and 3 cases of delivery at 37 weeks.5 cases were pregnant to second trimester,containing 4 cases received hysterectomy and 1 case suffered subtotal hysterectomy.2 cases were pregnant to first pregnancy, including 1 case of abdominal nidus resection, 1 case of ultrasound-guided dilation and curettage;Among the13 patients, 4 cases underwent bladder rupture, 4 cases lost uterus, 5 cases were admitted to the ICU, and 10 cases required blood transfusion.Placental implantation occurred in 11 cases who were pregnant to second and third trimester.CONCLUSION: Most of CSP with expecting treatment will develop into placenta implantation inevitably in the late stage of pregnancy.The patients with CSP can be pregnant again after early intervention and have extremely low possibility of a second CSP.

Prevention of poor healing of uterine incision and cesarean scar diverticulum after cesarean section / 中国实用妇科与产科杂志

As a long-term complication of cesarean section,previous cesarean scar diverticulum(PCSD)has attracted more and more attention in recent 10 years.PCSD increases the risk of two major obstetrical complications:uterine rupture and placenta accreta.Moreover,long-term adverse outcomes include pain,abnormal uterine bleeding,intraperitoneal adhesions and infertility.This article discusses the preventive measures of PCSD from the following aspects:the choice of uterine incision,the technique of uterine suture,the choice of suture materials and the management of postoperative short-term complications.

Treatment Efficacy Analysis in Patients with Type Ⅱ Cesarean Scar Pregnancy Treated with Different Minimally Invasive Surgical Methods / 中国医科大学学报

Objective To discuss the clinical effects of hysteroscopy and hysteroscopy combined with laparoscopy on typeⅡcesarean scar pregnancy (CSP). Methods We selected 58 patients diagnosed as having typeⅡCSP in Shengjing Hospital, China Medical University, between February 2013 and January 2016. Group A consisted of 36 patients who were treated with hysteroscopic CSP resection, while group B consisted of 22 patients treated with hysteroscopy combined with laparoscopic CSP resection and uterine repair. We compared the operation condition, single-operation success rate, postoperative recovery, and succeeding pregnancy outcome. Results The operation time in group A was 26.6±4.9 min, which was obviously shorter than that in group B. The bleeding volume in group A was 71.9±9.7 mL, which was obviously less than that in group B. No operation complication occurred in the two groups. The single-operation success rate was83.3％ in group A and 86.4％ in group B, indicating no significant difference. No significant differences in menstruation recovery and the rate of decrease in human chorionic gonadotropin level to normal were found between groups A and B. Conclusion Both hysteroscopy and hysteroscopy combined with laparoscopy can be used to treat typeⅡcesarean scar pregnancy.

Clinical efficacy of vaginal repair for type Ⅱ cesarean scar pregnancy / 局解手术学杂志

Objective To explore the clinical efficacy of vaginal hysterectomy and uterine scar repair in the treatment of type Ⅱ cesare-an scar pregnancy. Methods A total of 157 patients with type Ⅱ cesarean scar pregnancy (CSP) admitted to our obstetrics and gynecology department of our hospital from July 2016 to July 2017 were selected as research subjects. They were divided into ultrasound curettage group (n =87) and vaginal repair group(n =70) according to different surgical methods. The surgical bleeding volume, operative time, hospital stay and human chorionic gonadotropin (β-HCG) level before and after operation,the time of blood β-HCG returning to normal level,hemoglobin (HB) level before and after operation,menstrual recovery time,stress response, inflammatory response and surgical complications were compared between the two groups. Results The intraoperative blood loss volume, operative time and hospital slay in ultrasound curettage group were lower than those in vaginal repair group,the difference was significant(P ＜0.05). The time of blood β-HCG returning to normal level in vaginal repair group after operation was shorter than that in ultrasound curettage group, the difference was significant (P ＜ 0. 05). There was no significant difference in the HB level between the two groups(P＞0.05). The menstrual recovery time in vaginal repair group was shorter than that in ultrasound curettage group,the difference was significant(P ＜0. 05). The levels of postoperative epinephrine (E) and Cortisol (Cor) in vaginal repair group after operation were lower than those in ultrasound curettage group, while the level of thyroid stimulating hormone (TSH) was higher than that in ultrasound curettage group,the difference was significant(P ＜0.05). The levels of IL-2, IL-6 and IL-8 in vaginal repair group after operation were lower than those in ultrasound curettage group while the level of C-reactive protein (CRP) was higher than that in ultrasound curettage group,the difference was significant(P ＜0.05). The incidence rate of postoperative complications in ultrasound curettage group was higher than that in vaginal repair group(P ＜0. 05). Conclusion Vaginal repair is more beneficial to shortern the time of blood β-HCG returning to normal level and menstrual recovery time, promote the inflammatory factor and hormone recovery to a normal level, and reduce the incidence of complication.

Research progress of epidemiological characteristics and influencing factors of cesarean scar defect after cesarean section / 复旦学报（医学版）

With the rising rate of cesarean section (CS),the presence of a niche at the site of a CS scar,one of the potential long-term morbidity of CS,has also been increasingly observed.Currently,there are no standard diagnostic methods for evaluating cesarean scar defect (CSD).The incidence and prevalence of CSD are also not well established.Risk factors of CSD occurrence include history of CS,factors affecting labor,uterine position,closure technique,and factors related to immunity and inflammation.It is important to further study the epidemiology of CSD in order to prevent,treat and improve prognosis of CSD.

Cesarean scar pregnancy: “A rarity no more?” A report of 2 cases / Philippine Journal of Obstetrics and Gynecology

@#Cesarean scar pregnancy is the rarest form of ectopic pregnancy. In the Philippines, little is known about its incidence and occurrence. However, increasing rates has been documented worldwide, closely related to the increasing cesarean section rates. This paper reports two cases of cesarean scar pregnancy who both presented with vaginal bleeding. The first case, a Gravida 6 Para 5 (5005), while the second case, a Gravida 3 Para 2 (2002). Both diagnosed early by ultrasonography but managed differently. The first case, managed by hysterectomy, while the second case, managed conservatively by laparoscopic excision of the cesarean scar pregnancy. This paper intends to raise awareness of the increasing incidence of cesarean scar pregnancy, its pathophysiology, different options in the diagnosis and management. Prevention is the key to decrease the incidence of cesarean scar pregnancy. To achieve this, reducing the cesarean section rate should be the primary goal.

Clinical effect of transvaginal and laparoscopic operation methods for treating exogenous uterine cesarean scar pregnancy / 重庆医学

Objective To study the clinical curative effect of transvaginal and laparoscopic operation methods for treating exogenous uterine cesarean scar pregnancy.Methods Sixty patients with exogenous uterine CSP in our hospital from August 2013 to August 2016 were selected and divided into the two groups with 30 cases in each group.The control group adopted laparoscopic lesion resection,while the observation group adopted transvaginal lesion excision of lower uterine segment.Then the operation situation,postoperative VAS score,β-HCG levels and traumatic response indexes were compared between the two groups.Results The hospitalization time had no statistical difference between the two groups(P＞0.05).The hospitalization cost,blood loss volume and anal exhaustion time in the observation group were less than those in the control group(P＜0.05).The β-HCG level before and after operation had no statistical difference between the two groups (P＞0.05).The VAS score and traumatic response indexes in the observation group were better than those in the control group(P＜0.05).The complication occurrence rate in the observation group was lower than that in the control group(P＜0.05).Conclusion Transvaginal lesion excision of lower uterine segment in the treatment of exogenous uterine CSP has better curative effect and safety.

Ultrasound-guided local injection of methotrexate and systemic intramuscular methotrexate in the treatment of cesarean scar pregnancy

OBJECTIVE: To assess the efficacy and safety of ultrasound-guided intragestational injection of methotrexate (MTX) and systemic intramuscular MTX in the management of cesarean scar pregnancies. METHODS: This was a retrospective case-control study that included women diagnosed with cesarean scar pregnancy at CHA Bundang Medical Center unit between 2009 and 2015. The 26 cases were managed with local injection of MTX under ultrasound guidance and 15 cases were treated with systemic intramuscular of MTX. After the procedure, serial follow-up sonographic examination and serum beta-human chorionic gonadotropin (β-hCG) measurement were performed. RESULTS: The mean initial β-hCG level was 20,610.73 mIU/mL and ranged from 263.00–71,316.50 mIU/mL. Mean gestational age was 6.3 weeks and ranged from 4.8 to 8.5 weeks. The majority of ectopic cases were treated successfully and follow-up β-hCG level declined abruptly following the first dose of MTX. The rate of success of local MTX treatment was significantly higher than that of systemic MTX treatment. It was 93.75% vs. 73.33%, respectively (P < 0.05). CONCLUSION: Ultrasound-guided intragestational injection of MTX is an effective method for the management of cesarean scar pregnancies and is associated with minimal side effects and high treatment success.

Tratamiento conservador del embarazo ectópico en cicatriz de cesárea previa: reporte de un caso clínico / Conservative treatment of the ectopic cesarean scar pregnancy: report of a clinical case

El embarazo localizado dentro de una cicatriz de cesárea previa es el menos frecuente de los embarazos ectópicos y no existe un tratamiento estándar. Se presenta el caso de una paciente de sexo femenino de 33 años de edad, que ingresó por el servicio de emergencias de Ginecología y Obstetricia del Hospital Obrero Nº2, con reporte ecográfico de embarazo de 6,3 semanas, a nivel de cicatriz de cesárea previa, con embrión único con actividad cardiaca; por la solicitud de la paciente de preservar la fertilidad se le ofreció tratamiento médico con metotrexato.

The pregnancy located within the previous cesarean section scar is the less frequent of the ectopics pregnancies and a standard treatment doesn't exist. We present the case of a 33 year-old female patient admitted by the Servicio de Emergencias de Ginecología y Obstetricia del Hospital Obrero Nº2, with ultrasonography report of pregnancy of 6,3 weeks, and ectopic cesarean scar pregnancy, with single embryo with heart activity; By the request of the patient to preserve fertility were offered treatment medical with metotrexato.