The Diagnosis and Treatment for a Special Type of Cesarean Scar Pregnancy

Shili Su, Jinping Liu, Baihua Dong^*

Department of Gynecology and Obstetrics, Qilu Hospital of Shandong University, Jinan, China.

DOI: 10.4236/ojog.2015.58061                

Abstract

Caesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy, and its incidence has been increased due to the increased rate of Cesarean sections performed. A special type of CSP, concealed CSP, was found in the clinical work in our institution. A retrospective review was performed. From September 2011 to June 2014, 208 women were presented with cesarean scar pregnancy by use of transvaginal color Doppler sonography. The medical records were consulted to collect the demographics and pertinent information. Six of them were determined to be concealed CSP. Four women were diagnosed in the first-trimester pregnancy after termination of pregnancy. The initial ultrasound of the other two women displayed that the gestational sacs were located in the lower uterine cavity. Placenta accrete, increta and previa were diagnosed by the following ultrasounds. Concealed CSP is a very unusual form of CSP. Continued pregnancy may be sufficiently evaluated because of subsequently serious complications. Our results indicate that continued pregnancy increases the risk of laparotomy and hysterectomy. Medical abortion in the first-trimester pregnancy should be considered as the optimal choice for the women with prior cesarean sections who want to terminate the gestation.

Keywords

Cesarean Scar Pregnancy, Diagnosis, Treatment, Ultrasound

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Larsen, J.V. and Solomon, M.H. (1978) Pregnancy in a Uterine Scar Sacculus—An Unusual Cause of Postabortal Haemorrhage. A Case Report. South African Medical Journal, 53, 142-143.
[2]	Seow, K.M., Huang, L.W., Lin, Y.H., Lin, M.Y., Tsai, Y.L. and Hwang, J.L. (2004) Caesarean Scar Pregnancy: Issues in Management. Ultrasound in Obstetrics & Gynecology, 23, 247-253. http://dx.doi.org/10.1002/uog.974
[3]	Jurkovic, D., Hillaby, K., Woelfer, B., Lawrence, A., Salim, R. and Elson, C.J. (2003) First-Trimester Diagnosis and Management of Pregnancies Implanted into the Lower Uterine Segment Cesarean Section Scar. Ultrasound in Obstetrics & Gynecology, 21, 220-227. http://dx.doi.org/10.1002/uog.56
[4]	Ash, A., Smith, A. and Maxwell, D. (2007) Caesarean Scar Pregnancy. BJOG: An International Journal of Obstetrics & Gynaecology, 114, 253-263. http://dx.doi.org/10.1111/j.1471-0528.2006.01237.x
[5]	Ozkan, S., Caliskan, E., Ozeren, S., Corakci, A., Cakiroglu, Y. and Coskun, E. (2007) Three-Dimensional Ultrasonographic Diagnosis and Hysteroscopic Management of a Viable Cesarean Scar Ectopic Pregnancy. Journal of Obstetrics and Gynaecology Research, 33, 873-877. http://dx.doi.org/10.1111/j.1447-0756.2007.00671.x
[6]	Timor-Tritsch, I. and Monteagudo, A. (2012) Unforeseen Consequences of the Increasing Rate of Cesarean Deliveries: Early Placenta Accrete and Cesarean Scar Pregnancy. A Review. American Journal of Obstetrics & Gynecology, 207, 14-29. http://dx.doi.org/10.1016/j.ajog.2012.03.007
[7]	Herman, A., Weinraub, Z., Avrech, O., Maymon, R., Ron-El, R. and Bukovsky, Y. (1995) Follow up and Outcome of Isthmic Pregnancy Located in a Previous Caesarean Section Scar. BJOG: An International Journal of Obstetrics & Gynaecology, 102, 839-841. http://dx.doi.org/10.1111/j.1471-0528.1995.tb10855.x
[8]	Ben-Nagi, J., Ofili-Yebovi, D., Marsh, M. and Jurkovic, D. (2005) First Trimester Cesarean Scar Pregnancy Evolving into Placenta Previa/Accreta at Term. Journal of Ultrasound in Medicine, 24, 1569-1573.
[9]	El-Matary, A., Akinlade, R. and Jolaoso, A. (2007) Caesarean Scar Pregnancy with Expectant Management to Full Term. Journal of Obstetrics & Gynaecology, 6, 624-625. http://dx.doi.org/10.1080/01443610701546334
[10]	Jurkovic, D. (2014) Cesarean Scar Pregnancy and Placenta Accreta. Ultrasound in Obstetrics & Gynecology, 43, 361-362. http://dx.doi.org/10.1002/uog.13346