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Cesarean scar ectopic pregnancy is associated with significant maternal morbidity, including severe hemorrhage, need for the blood transfusion and hysterectomy. Early diagnosis is therefore key in ensuring timely management, with consensus being that treatment before 9 weeks of gestation leads to reduced morbidity. There is no universally adopted management protocol for cesarean scar ectopic pregnancy, but surgical management generally has a higher success rate than medical management. The primary surgical treatment modalities are suction evacuation versus resection of the pregnancy via multiple routes. Adjuncts that have been shown to successfully minimize bleeding with surgical management include cervical cerclage, balloon catheter, and uterine artery embolization. However, there remains a lack of high-quality evidence regarding what is the best surgical treatment option for cesarean scar ectopic pregnancy, and therefore it is essential that clinicians provide tailored management to patients considering the presenting symptoms and local expertise with various surgical techniques. 相似文献
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Cesarean scar ectopic pregnancy is a rare type of ectopic pregnancy, where the pregnancy implants into a myometrial defect caused by a cesarean scar. Its incidence is predicted to increase, given the global increase in cesarean deliveries. As most cesarean scar ectopic pregnancies present as failing pregnancies or patients choose termination of pregnancy, there are limited data on their natural history. However, early first trimester diagnosis is essential, given the associated significant maternal morbidity. Transvaginal sonography is generally considered to be the optimal method for diagnosing cesarean scar ectopic pregnancy. There is no evidence that MRI adds to the diagnostic accuracy, and it is therefore not recommended for routine evaluation of cesarean scar ectopic pregnancy. There is no agreed reference standard for the diagnosis of cesarean scar ectopic pregnancy; therefore, the validity of several proposed sonographic diagnostic criteria reported by different authors remains unknown. There are also various suggested classification systems for cesarean scar ectopic pregnancy, which divide them in differet types. However, the proposals are very heterogeneous, and superiority of one classification system over another is yet to be established. 相似文献
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Three-dimensional ultrasonographic diagnosis and hysteroscopic management of a viable cesarean scar ectopic pregnancy 总被引:2,自引:0,他引:2
Ozkan S Calişkan E Ozeren S Corakçi A Cakiroğlu Y Coşkun E 《The journal of obstetrics and gynaecology research》2007,33(6):873-877
Implantation of conception material within a cesarean section scar is an extremely rare form of ectopic pregnancy with devastating complications, such as uterine rupture and intractable bleeding. Both 2-D and 3-D transvaginal ultrasonographic devices are used adequately for precise diagnosis, but there is still a lack of consensus concerning management strategies. No therapeutic modality is suggested to be entirely efficacious and safe for preserving uterine integrity. We present here a 29-year-old woman with vaginal bleeding and a gestational sac with a viable embryo of 6 weeks of age that was implanted in a cesarean section scar. Serum beta-hCG levels were 16 792 mIU/mL. Following an unsuccessful treatment course of systemic methotrexate, the patient underwent operative hysteroscopy. Minimally invasive hysteroscopic resection of the ectopic gestational mass without major complication appears to be an alternative therapeutic approach with minimal morbidity and preservation of future fertility. 相似文献
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Shih-Wei Tsai Kuan-Hui Huang Yu-Che Ou Te-Yao Hsu Chen-Bin Wang Ming-Shan Chang Ko-Hsin Li Fu-Tsai Kung 《Taiwanese journal of obstetrics & gynecology》2013,52(4):505-511
ObjectiveTo describe the treatment outcomes of aberrant ectopic implantations in the lower segment of the uterus in a cohort population and to evaluate whether or not low-lying-implantation ectopic pregnancy (LLIEP), a new term, is appropriate to include in the traditional diagnoses of cervical pregnancy (CP), cesarean scar pregnancy (CSP), and other unusual aberrant implantations in the lower segment of the uterus in the first trimester, in terms of clinical characteristics, treatment, and prognosis.Materials and methodsForty-two women with ectopic pregnancies of <12 weeks' gestational age from July 2003 to December 2008 were prospectively studied. Each patient underwent an ultrasound evaluation by an experienced consultation team and was grouped into the CP, CSP, or cervico-isthmic pregnancy (CIP) group. Patients underwent either suction dilatation and curettage (D and C) alone, or laparoscopic uterine artery blockage followed by suction D and C, to remove the aberrant trophoblasts without other adjuvant treatments. Clinical characteristics and biochemical factors, including obstetric history, patient age, body mass index (BMI), gestational age, serum hematocrit and β-hCG level, operation method, operation time, and intraoperative blood loss were evaluated.ResultsThere were no significant differences in patient age (mean = 34.1 ± 6.4 years), previous number of cesarean deliveries (mean = 1.5 ± 0.8), gestational age (mean = 6.9 ± 1.2 weeks), serum β-hCG (mean = 35,384.3 ± 41,726.9 mIU/mL), operation time (mean = 60.3 ± 46.6 minutes), and surgical blood loss (mean = 124.7 ± 191.5 mL) among the three patient groups. The uterus was successfully preserved in all patients after treatment.ConclusionThe prognosis of surgical management for ectopic implantations in the lower segment of the uterus is good. The new term LLIEP seems appropriate to cover all forms of aberrant ectopic implantations in the lower segment of the uterus in the first trimester, in terms of treatment efficacy. The use of LLIEP for preoperative ultrasound diagnosis would enable the clinician to diagnose unusual cases more easily, without the need to change the current treatment policy. 相似文献
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Objective
With the incidence of cesarean scar pregnancy (CSP) rising, the reports of serious adverse outcomes of it have increased gradually. The management of CSP remains an inadequately explored clinical field, and there is no consensus on it presently. The present study was performed to investigate the efficacy and safety of operative hysteroscopy in the diagnosis and treatment of CSP.Materials and methods
Forty-four patients with CSP underwent operative hysteroscopy for removal of scar ectopic pregnancy in our institution. Among them, hysteroscopy was combined with laparoscopy in two patients, three cases with massive hemorrhage were pretreated with bilateral uterine artery embolization before hysteroscopic surgery, and four patients were pretreated with mifepristone (200 mg for 3 days) and methotrexate (25 mg for 2 days). Clinical data, serum β-human chorionic gonadotropin, myometrial thickness, residual conceptus, cesarean scar defect, operation time, blood loss, and hospital stay were recorded.Results
All of the ectopic gestations were removed entirely by operative hysteroscopy. Mean operation time was 34.8 ± 16.5 minutes (range 20–120 minutes), and mean blood loss was 35.3 ± 24.4 mL (range 5–100 mL). The mean hospital stay was 5.0 ± 3.01 days (range 1–19 days). Cesarean scar defect could be diagnosed in 70% (31/44) of patients, while in 20/32 cases (63%), a conceptus remained after uterine curettage only was performed.Conclusion
Operative hysteroscopy might be recommended as a first-line treatment modality for patients with a cesarean scar ectopic pregnancy, especially when myometrium thickness between bladder and gestational sac is more than 3 mm. 相似文献12.
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Kaijima H Osada H Kato K Segawa T Takehara Y Teramoto S Kato O 《Journal of assisted reproduction and genetics》2006,23(6):293-298
Purpose: To describe the efficacy and safety of managing ectopic pregnancies (EP) with ultrasound-guided local injections of absolute ethanol (AE).
Methods: 69 cases of EP following IVF performed in our clinic were treated with a local injection of 0.3 ml AE with a 23-gauge needle under transvaginal ultrasonic guidance. The efficacy was evaluated comparing serum beta-human chorionic gonadotropin (β-hCG) levels before and after the injection.
Results: In the 60 successful cases (87%), the serum β-hCG level decreased by 10–30% in two hours postinjection. Of these, 46 were effective with a single injection and the half-life of β-hCG was achieved within 4 days in 45 cases. In 56 cases (including repetitive administration) serum β-hCG levels decreased to 20 mIU/mL within 20 days. The treatment showed no side effects and could be given on an outpatient basis without anesthesia.
Conclusions: This method was shown to be a safe, effective new approach to treating EP.Transvaginal ultrasound-guided local injections of absolute ethanol are a safe and effective approach to treating ectopic pregnancies. 相似文献
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Hwang JH Lee JK Lee NW Lee KW 《European journal of obstetrics, gynecology, and reproductive biology》2011,156(1):78-82
Objective
To compare laparotomy and laparoscopic management of interstitial ectopic pregnancies.Study design
The medical records of 109 patients diagnosed with interstitial ectopic pregnancies at the Korea University Medical Center, the Republic of South Korea, between January 1998 and October 2009 were reviewed retrospectively. Eighty-eight women were treated by open cornual resection or laparoscopic cornual resection. A case-controlled study was performed. The outcomes were operative time, length of hospital stay, estimated blood loss, blood transfusion, and complication. Nominal variables were analyzed by the Fisher's exact test or the χ2 test.Results
The frequency of cornual ectopic pregnancies was 4.31% at this medical center. In patients with a cornual resection, primary laparotomy was performed in 49 women and laparoscopy was performed in 39 women. Laparoscopy was converted to laparotomy in five patients. There were no statistically significant differences between the two groups for the mean operation time, estimated blood loss, blood loss of more than 1000 mL, blood transfusion requirements, and complications. The mean number of postoperative hospital days was shorter in the laparoscopy group than in the laparotomy group (4.53 ± 1.44 days versus 5.89 ± 1.86 days, respectively; P < 0.001).Conclusion
Laparoscopic cornual resection is a safe and less invasive procedure with a reasonable complication rate and shorter hospital stay. 相似文献15.
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To evaluate whether contrast-enhanced magnetic resonance imaging (MRI) could be used as a routine method for diagnosing cesarean scar pregnancy (CSP).Methods
A retrospective study was performed, with review and analysis of medical records, ultrasonography results, MRI results, and clinical outcomes of 44 women with CSP admitted to Beijing Chaoyang Hospital, Beijing, China, between May 2010 and November 2013. The women initially underwent ultrasonography followed approximately 5 days later by contrast-enhanced MRI.Results
CSP was accurately diagnosed in 42 cases (95.5%) using contrast-enhanced MRI compared with 39 cases (88.6%) using ultrasonography (P < 0.05). Two cases with a heterogeneous signal intensity pattern using MRI were initially misdiagnosed as a uterine leiomyoma and a trophoblastic tumor. No contrast agent-related complications occurred. The typical findings of a gestational sac embedded in the anterior lower part of the uterus in the sagittal T2-weighted views were identified in all the patients. All patients recovered well without experiencing major morbidity after treatment.Conclusion
Contrast-enhanced MRI could be used as a reliable adjunct and initial imaging modality for diagnosing CSP in select cases. The imaging features of contrast-enhanced MRI may result in a more accurate diagnosis before specific treatment for CSP. 相似文献18.
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经阴道手术是治疗剖宫产瘢痕妊娠安全、有效的治疗方法之一,适用于孕<10周、妊娠包块最大径线<6cm的患者,其术前无需预处理。经阴道手术治疗剖宫产瘢痕妊娠对未来妊娠的影响、失败的相关因素及与其他一线治疗方法之间的比较,还需要多中心、大样本的临床研究进行总结。 相似文献
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Luis R. Hoyos Gustavo Vilchez Jenifer E. Allsworth Mokerrum Malik Javier Rodriguez-Kovacs Henry Adekola 《The journal of maternal-fetal & neonatal medicine》2019,32(14):2354-2360
Objective: The objective of this study is to evaluate pregnancy outcomes in patients with a history of wedge resection for interstitial ectopic pregnancy (WRIEP).Methods: Retrospective cohort study of pregnancies with a history of WRIEP from 2000 to 2013 at two inner city hospitals in Detroit, MI. Pregnant-matched controls (1:3) were selected and included patients with history of surgically treated tubal ectopic pregnancy and delivered patients without history of ectopic pregnancy. Pregnancy outcomes, including a composite, were compared among the groups.Results: Eighty-three cases of interstitial pregnancy were identified. Sixty-three (75.9%) underwent WRIEP from which 19 (30.2%) had a subsequent pregnancy and 11 (57.9%) carried it ≥20 weeks. No difference in subsequent pregnancy outcomes including the composite was found among patients with prior WRIEP and patients with history of surgically treated tubal ectopic pregnancy except for a longer interpregnancy interval. Compared with delivered patients without a history of ectopic pregnancy, no difference in late obstetric outcomes was found including the composite, gestational age at delivery in weeks (38.2 versus 38.1, p?=?.955), preterm delivery rate (30% versus 21%, p?=?.674), and proportion of term vaginal (40% versus 52%, p?=?.721) or cesarean deliveries (60% versus 30%, p?=?.137). The most common indication for cesarean among patients with a history of WRIEP was a history of such (5/6, 83.3%) and there were no cases of abnormal placentation.Conclusion: Findings suggest that a history of WRIEP is not associated with increased risk of adverse pregnancy outcomes. 相似文献