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.

Management of caesarean scar ectopic pregnancy: a case report

Caesarean scar ectopic involves an abnormal implantation of the embryo within the myometrium of previous caesarean scar. It is a rare and serious entity involving maternal complication like abnormal placentation, hemorrhage or death due to uterine rupture. Authors present a case report of 32 years old female diagnosed as a case of caesarean scar ectopic pregnancy on TVS and MRI and managed conservatively by USG guided D and C.

A rare case of lower segment scar pregnancy

Caesarean scar ectopic is one of the rarest of all ectopic pregnancies. The incidence of caesarean scar ectopic has increased due to increase in number of caesarean deliveries. A 31-year-old woman (G4P3003) presented from an outside facility to Sola Civil Hospital with vaginal bleeding and discharge with no abdominal pain or any discomfort. The gestational sac was located in an anterior position toward the anterior lower uterine segment at the level of prior caesarean scar with little visible myometrium noted anterior to the gestational sac in the lower uterine segment and Tissue was sent for histopathological examination and diagnosis of caesarean scar ectopic pregnancy was confirmed. Reports found that It is life threatening condition, causes excessive hemorrhage and risk of uterine rupture. The diagnosis of this type of ectopic pregnancy is very difficult and false negative diagnosis can lead to major complications.

Cesarean scar ectopic with ruptured corpus luteal cyst: a rare case report

Incidence of caesarean scar pregnancy (CSP) is increasing because of a rising number of caesarean sections. Prompt diagnosis of the condition is required to reduce associated morbidity. A high index of suspicion is required for women with a suggestive history of CSP. Ultrasound scan is the diagnostic tool of choice. Management options include medical, surgical and interventional radiology. Appropriate patient selection is important for optimal results. Major haemorrhage and hysterectomy are the main risks associated with CSP. Therefore, adequate counselling and availability of surgical expertise and blood transfusion should be part of a comprehensive management strategy. We are reporting a rare case of G3P2L1 with previous two lower caesarean deliveries diagnosed with caesarean scar ectopic based on clinical and ultrasound finding came with acute pain in abdomen with haemodynamically unstable with intraoperative finding s/o unruptured c scar pregnancy along with ruptured corpus luteal cyst leading to severe intra-abdominal bleeding. C-scar ectopic and corpus luteal cyst confirmed on histopathology.

Successful management of a triplet heterotropic caesarean scar pregnancy in spontaneous conception

A cesarean scar ectopic pregnancy -CSEP is a fairly uncommon presentation wherein the conceptus is implanted at the exact scar site of the previous cesarean section deep in the myometrium. Given the relatively rare incidence of CSEP establishing a diagnosis of CSEP can be challenging current standards of therapy have been derived from data obtained from a limited number of patient’s management options for CSEP range from medical line of treatment to surgical interventions such as sonography guided injections to laparoscopic excision or laparotomy or combination of these modalities. Herein we report a rare case of triplet pregnancy with one gestation sac implanted at the site of lower segment scar diagnosed on transvaginal ultrasonography along with MRI who was managed successfully with systemic methotrexate.