LONG-TERM RISKS OF CESAREAN DELIVERY: CESAREAN SCAR PREGNANCY. A SYSTEMATIC REVIEW
https://doi.org/10.17749/2313-7347.2017.11.4.048-056
Abstract
One type of ectopic pregnancy is where the pregnancy is implanted in the scar left in the uterus following a cesarean section; these cases are thought to be one in 1800-3000 pregnancies. The increase in the incidence of cesarean scar pregnancy (CSP) is a consequence of the increasing rates of cesarean delivery. If misdiagnosed CSP can be a cause of life-threatening pregnancy complications. They include morbidly adherent placenta, placenta previa, and severe hemorrhage. If such a pregnancy is allowed to continue, a uterine scar rupture with hemorrhage will ensue and necessitate hysterectomy. It is therefore crucial to timely diagnose and manage these pregnancies. The therapeutic options can be medical, surgical, or a combination of both. However there has been no consensus on the management still yet. In this article, there is a systematic up-to-date review on CSP diagnosis, treatment and prevention measures.
About the Authors
A. E. Sidorov
Chuvash State University named after I.N. Ulyanov.
Russian Federation
Russian Federation
Sidorov Anatoliy Evgenevich – PhD, Assistant Professor, Obstetrics and Gynecology Department n.a. G.M. Vorontsova.
pr-kt Moskovskiy, 15, Cheboksary, 428015.
A. G. Gunin
Chuvash State University named after I.N. Ulyanov.
Russian Federation
Russian Federation
Gunin Andrei Germanovich – MD, Professor, Obstetrics and Gynecology Department n.a. G.M. Vorontsova.
pr-kt Moskovskiy, 15, Cheboksary, Russia, 428015.
V. V. Chernyshov
Chuvash State University named after I.N. Ulyanov.
Russian Federation
Russian Federation
Chernyshov Vitaliy Vasilyevich – PhD, Assistant Professor, Obstetrics and Gynecology Department n.a. G.M. Vorontsova.
pr-kt Moskovskiy, 15, Cheboksary, Russia, 428015.
References
1. Gynecology. National leadership. Short edition [Ginekologiya. Nacional'noe rukovodstvo. Kratkoe izdanie (Pod red. G.M. Savel'evoj, G.T. Suhih, I.B. Manuhina)]. Moskva: GEOTAR-Media. 2013: 638 s (in Russian).
2. Emergency medicine. Selected clinical lectures [Medicina neotlozhnyh sostoyanij. Izbrannye klinicheskie lekcii. Tom 4. 2-e izd., ispr. i dop. (Pod red. V.V. Nikonova, A.E. Fes'kova, B.S. Fedaka)]. Doneck: Izdatel' Zaslavskij A.Yu. 2012: 512 s (in Russian).
3. Healthcare in Russia. 2015. Statistical collection [Zdravoohranenie v Rossii. 2015. Statisticheskij sbornik]. Moskva: Rosstat. 2015: 174 s (in Russian).
4. Creanga A.A., Berg C.J., Syverson C., Seed K., Bruce C., Callaghan W.M. Pregnancy-related mortality in the United States, 2006-2010. Obstet Gynecol. 2015; 125 (1): 5-12.
5. Marion L. L., Meeks G. R. Ectopic pregnancy: history, incidence, epidemiology, and risk factors. Clin Obstet Gynecol. 2012; 55 (2): 376-86.
6. Comprehensive gynecology [Eds. G.M. Lentz, R.A. Lobo, D.M. Gershenson, V.L. Katz]. 6th ed. Philadelphia, PA: Elsevier Health Sciences. 2012: 869 s.
7. Fylstra D.L. Ectopic pregnancy not within the (distal) fallopian tube: etiology, diagnosis, and treatment. Am J Obstet Gynecol. 2012; 206 (4): 289-99.
8. Timor-Tritsch I.E., Monteagudo A. Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy. A review. Am J Obstet Gynecol. 2012; 207 (1): 14-29.
9. Ash A., Smith A., Maxwell D. Caesarean scar pregnancy. BJOG Int J Obstet Gynecol. 2007; 114 (3): 253-63.
10. Maymon R., Svirsky R., Smorgick, N. et al. Fertility performance and obstetric outcomes among women with previous cesarean scar pregnancy. J Ultrasound Med. 2011; 30 (9): 1179-84.
11. Sadeghi H., Rutherford T., Rackow B.W. et al. Cesarean scar ectopic pregnancy: case series and review of the literature. Am J Perinatol. 2010; 27 (2): 111-20.
12. Wang X., Zhang J., Zhao W.S. et al. Caesarean deliveries in China. BMC Pregnancy and Childbirth. 2017; 17 (1): 54.
13. Osborn D.A., Williams T.R., Craig B.M. Cesarean Scar Pregnancy Sonographic and Magnetic Resonance Imaging Findings, Complications, and Treatment. J Ultrasound Med. 2012; 31 (9): 1449-56.
14. Sarkisov S.E., Romanovskaya O.A., Demidov A.V., Belousov D.M. Application of echography to diagnose pregnancy in the rumen on the uterus after cesarean section [Primenenie ekhografii dlya diagnostiki beremennosti v rubce na matke posle kesareva secheniya]. Ul'trazvukovaya i funkcional'naya diagnostika. 2009; 2: 36-42 (in Russian).
15. Makukhina T.B., Pomortsev A.V. Features of ultrasound diagnosis and treatment tactics in the management of patients with pregnancy in the rumen after cesarean section [Osobennosti ul'trazvukovoj diagnostiki i lechebnoj taktiki pri vedenii pacientok s beremennost'yu v rubce posle kesareva secheniya]. Rossijskij elektronnyj zhurnal luchevoj diagnostiki. 2012; 2 (3): 95-9 (in Russian).
16. Chechneva M.A., Panov A.E., Fedorov A.A., Blagina E.I. Possibilities of ultrasound diagnosis and management of pregnancy in the presence of a scar on the uterus [Vozmozhnosti ul'trazvukovoj diagnostiki i vedeniya beremennosti pri nalichii rubca na matke]. SonoAce Ultrasound. 2015; 27: 3-10 (in Russian).
17. Clinical recommendations. Obstetrics and gynecology [Klinicheskie rekomendacii. Akusherstvo i ginekologiya. 4-e izd., pererab. i dop. (Pod red. V.N. Serova, G.T. Suhih)]. Moskva: GEOTAR-Media. 2014: 1024 s (in Russian).
18. Roca L.E., Hoffman M.C., Gaitan L.F, Burkett G. Placenta percreta masquerading as an acute abdomen. Obstet Gynecol. 2009; 113 (2 Pt 2): 512-4.
19. Hong S.C., Lau M.S.K., Yam P.K.L. Ectopic pregnancy in previous Caesarean section scar. Singapore Med J. 2011; 52 (6): 115-7.
20. Timor-Tritsch I.E., Monteagudo A., Cali G. et al. Cesarean scar pregnancy and early placenta accreta share common histology. Ultrasound Obstet Gynecol. 2014; 43 (4): 383-95.
21. Kim K., Pietrzak A., Gonzalez S., Podgony K. Severe hemorrhage in a first-trimester cesarean scar pregnancy during dilation and curettage. Int J Obstetric Anesth. 2010; 19 (3): 348-9.
22. Zhang X. Panhysterectomy Resulting From a Residual Cesarean Scar Pregnancy After Dilatation and Curettage: A. Life Science Journal. 2014; 11 (1): 99-103.
23. Sidorov A.E., Sidorov E.S., Samoylova A.V. et al. Pregnancy in the rumen on the uterus after cesarean section [Beremennost' v rubce na matke posle kesareva secheniya]. Zdravoohranenie Chuvashii. 2014; 3: 49-56 (in Russian).
24. Jauniaux E., Jurkovic D. Placenta accreta: pathogenesis of a 20th century iatrogenic uterine disease. Placenta. 2012; 33 (4): 244-51.
25. Riaz R.M., Williams T.R., Craig B.M., Myers D.T. Cesarean scar ectopic pregnancy: imaging features, current treatment options, and clinical outcomes. Abdom Imaging. 2015; 40 (7): 2589-99.
26. Roberge S., Demers S., Berghella V. et al. Impact of single vs double-layer closure on adverse outcomes and uterine scar defect: a systematic review and metaanalysis. Am J Obstet Gynecol. 2014; 211 (5): 453-60.
27. Lee J.E., Choe S.A., Ku S.Y. et al. Successful conservative management of a viable Cesarean scar pregnancy: A case report. Korean J Obstet Gynecol. 2012; 55 (4): 274-7.
28. Radzinsky V.E. Obstetric aggression [Akusherskaya agressiya]. Moskva: Status Praesens. 2011: 688 s (in Russian).
29. Ben Nagi J., Helmy S., Ofili-Yebovi D.et al. Reproductive outcomes of women with a previous history of Caesarean scar ectopic pregnancies. Hum Reprod. 2007; 22 (7): 2012-5.
30. Lee S.R., Park S.Y., Park M.H. Cesarean scar pregnancy associated with an impending uterine rupture diagnosed with 3-dimensional ultrasonography. Am J Obstet Gynecol. 2017; 216: 531.
31. Timor-Tritsch I.E., Monteagudo A., Santos R. et al. The diagnosis, treatment, and follow-up of cesarean scar pregnancy. Am J Obstet Gynecol. 2012; 207 (1): 44. e1-13. DOI: 10.1016/j.ajog.2012.04.018.
32. Collins K., Kothari A. Catastrophic consequences of a caesarean scar pregnancy missed on ultrasound. Australasian J Ultrasound Med. 2015; 18 (4): 150-6.
33. Sorbi F., Sisti G., Pieralli A. et al. Cervicoisthmic choriocarcinoma mimicking cesarean section scar ectopic pregnancy. J Res Med Sci. 2013; 18 (10): 914-7.
34. Annappa M., Tripathi L., Mahendran M. Caesarean section scar ectopic pregnancy presenting as a fibroid. J Obstet Gynecol. 2009; 29 (8): 774.
35. Davari-Tanha F., Samimi-Sede S, Khalilpour Z. et al. Cesarean scar pregnancy misdiagnosed as gestation in bicornuate uterus. MJIRI. 2008; 22 (2): 101-3.
36. Jurkovic D., Ben-Nagi J., Ofilli-Yebovi D. et al. Efficacy of Shirodkar cervical suture in securing hemostasis following surgical evacuation of cesarean scar ectopic pregnancy. Ultrasound Obstet Gynecol. 2007; 30 (1): 95-100.
37. Molinaro T.A., Barnhart K.T. Ectopic pregnancies in unusual locations. Seminars in reproductive medicine. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA. 2007; 25 (2): 123-30.
38. Brar S., Byun S., Sims SM., Davis J.D. Cesarean Scar Ectopic Pregnancy: Three Cases Illustrating Divergent Treatment Options Where No Standard Management Exists. J Genit Syst Disord. 2013; 2 (1). DOI: 10.4172/2325-9728.1000104.
39. Hoffman B.L., Schorge J.O., Bradshaw K.D. et al. Williams Gynecology. New York: McGraw Hill Professional. 2016: 1296 s.
40. Zhang Y., Gu Y., Wang J.M., Li Y. Analysis of cases with cesarean scar pregnancy. J Obstet Gynaecol Res. 2013; 39 (1): 195-202.
41. Datta S., Jha C. Suction Evacuation with Methotrexate as a Successful Treatment Modality for Caesarean Scar Pregnancies: Case series. Sultan Qaboos Univ Med J. 2015; 15 (4): e539.
42. Zhang X.B., Zhong Y.C., Chi J.C. et al. Caesarean scar pregnancy: Treatment with bilateral uterine artery chemoembolization combined with dilation and curettage. J Int Med Res. 2012; 40 (5): 1919-30.
43. Jiang T., Liu G., Huang L., Ma H., Zhang S. Methotrexate therapy followed by suction curettage followed by Foley tamponade for caesarean scar pregnancy. Eur J Obstet Gynecol Reprod Biol. 2011; 156 (2): 209-11.
44. Jurkovic D., Knez J., Appiah A. et al. Surgical treatment of Cesarean scar ectopic pregnancy: efficacy and safety of ultrasound-guided suction curettage. Ultrasound Obstet Gynecol. 2016; 47 (4): 511-7.
45. Koplay M., Dogan N.U., Sivri M. et al. Ectopic Pregnancy in a Cesarean Section Scar: Successful Management Using Vacuum Aspiration under Laparoscopic Supervision – Mini Review of Current Literature. Case Reports in Surgery. 2016; 2016. Article ID 7460687. DOI: 10.1155/2016/7460687
46. Yamaguchi M., Honda R., Uchino K. et al. Transvaginal methotrexate injection for the treatment of cesarean scar pregnancy: Efficacy and subsequent fecundity. J Minim Invasive Gynecol. 2014; 21 (5): 877-83.
47. Mitwally M.F., Alami R., Albuarki H. et al. Gestational Sac Aspiration of Heterotopic Ectopic Pregnancy in a Cesarean Section Scar. J Gynecol Surg. 2013; 29 (6): 317-20.
48. Takeda A., Imoto S., Nakamura H. Abruptio placentae in subsequent pregnancy after conservative management of hemorrhagic cesarean scar pregnancy by transcatheter arterial chemoembolization. Clin Med Insights Case Rep. 2013; 6: 137-40.
49. Fylstra D.L. Hysteroscopy and suction evacuation of cesarean scar pregnancies: a case report and review. J Obstet Gynaecol Res. 2014; 40 (3): 853-7.
50. Mollo A., Conforti A., Alviggi C., De Placido G. Successful direct bipolar resection of 6th week cesarean scar pregnancy: case report and literature review. Eur J Obstet Gynecol Reprod Biol. 2014; 179: 229-31.
51. Wang G., Liu X., Bi F. et al. Evaluation of the efficacy of laparoscopic resection for the management of exogenous cesarean scar pregnancy. Fertil Steril. 2014; 101 (5): 1501-7.
52. Siedhoff M.T., Schiff L.D., Moulder J.K. et al. Robotic-assisted laparoscopic removal of cesarean scar ectopic and hysterotomy revision. Am J Obstet Gynecol. 2015; 212 (5): 681. e1-4.
53. Huanxiao Z., Shuqin C., Hongye J. et al. Transvaginal hysterotomy for cesarean scar pregnancy in 40 consecutive cases. Gynecol Surg. 2015; 12 (1): 45-51.
54. Wang H.Y., Zhang J., Li Y.N. et al. Laparoscopic management or laparoscopy combined with transvaginal management of type II cesarean scar pregnancy. JSLS. 2013; 17 (2): 263-72.
55. Wang G., Liu X., Wang D., Yang Q. Clinical analysis on selective uterine artery embolization combined with hysteroscopic surgery for exogenous cesarean scar pregnancy in 67 cases. Zhonghua Fu Chan Ke Za Zhi. 2015; 50 (8): 576-81.
56. Chang Y., Kay N., Chen Y.H. et al. Resectoscopic treatment of ectopic pregnancy in previous cesarean delivery scar defect with vasopressin injection. Fertil Steril. 2011; 96 (2): e80-2.
57. Robinson J.K., Dayal M.B., Gindoff P., Frankfurter D. A novel surgical treatment for cesarean scar pregnancy: laparoscopically assisted operative hysteroscopy. Fertil Steril. 2009; 92 (6): 1497. e13-6.
58. Xiao J., Zhang S., Wang F. et al. Cesarean scar pregnancy: noninvasive and effective treatment with high-intensity focused ultrasound. Am J Obstet Gynecol. 2014; 211 (4): 356. e1-7.
59. Rotas M.A., Haberman S., Levgur M. Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol. 2006; 107 (6): 1373-81.
60. Rizk B., Holliday C.P., Owens S., Abuzeid M. Cervical and Cesarean scar ectopic pregnancies: Diagnosis and management. Middle East Fertility Society Journal. 2013; 18 (2): 67-73.
61. Gubbini G., Centini G., Nascetti D. et al. Surgical hysteroscopic treatment of cesarean-induced isthmocele in restoring fertility: prospective study. J Minim Invasive Gynecol. 2011; 18 (2): 234-7.
62. Mahgoub S., Gabriele V., Faller E. et al. Cesarean scar ectopic pregnancy. Laparoscopic resection and total scar dehiscence repair. A case report. J Minim Invasive Gynecol. 2017. DOI: 10.1016/j. jmig.2017.01.022 [Epub ahead of print].
63. Luo L., Niu G., Wang Q. et al. Vaginal repair of cesarean section scar diverticula. J Minim Invasive Gynecol. 2012; 19 (4): 454-8.
64. Mahmoud M.S., Nezhat F.R. Robotic-assisted laparoscopic repair of a cesarean section scar defect. J Minim Invasive Gynecol. 2015; 22 (7): 1135-6.
65. Martin J.A., Hamilton B.E., Osterman M.J. et al. Births: Final Data for 2015. National Vital Statistics Reports. 2017; 66 (1): 1-69.
Review
For citations:
Sidorov A.E., Gunin A.G., Chernyshov V.V. LONG-TERM RISKS OF CESAREAN DELIVERY: CESAREAN SCAR PREGNANCY. A SYSTEMATIC REVIEW. Obstetrics, Gynecology and Reproduction. 2017;11(4):48-56. (In Russ.) https://doi.org/10.17749/2313-7347.2017.11.4.048-056
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