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Grossesse sur cicatrice de césarienne : un cas clinique de traitement conservateur

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L. Maheut
L. Maheut
L. Maheut
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S. Seconda
S. Seconda
S. Seconda
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Estelle Bauville at Centre Hospitalier Universitaire de Rennes
Estelle Bauville
J. Levêque
J. Levêque
J. Levêque
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Abstract

A caesarean scar pregnancy is a rare type of ectopic pregnancy which engages the vital prognosis either by hemorrhage or by early uterine rupture. We report the case of a 38-years-old patient who presented an ectopic pregnancy developed inside a previous caesarean section scar. The diagnosis was made at eight weeks of gestation by ultra-sound and allowed a fast management. We chose a conservative medical treatment by methotrexate both systemic and in situ. A hemorrhagic complication occured in two months of the initial treatment, requiring an endovascular therapy as well. Copyright 2010 Elsevier Masson SAS. All rights reserved.
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Identité :
BAUVILLE Estelle Adresse : 9 Bld Jeanne d’Arc
Appt 6
Née le 13/12/1974 à Pessac (33) 35 000 Rennes
Vivant maritalement
Pas d’enfant Téléphone : 06 62 19 66 83
E-mail : estelle.bauville@chu-rennes.fr
Cursus scolaire/ universitaire :
1992 : obtention baccalauréat D (mention assez-bien)
Lycée Max Linder, LIBOURNE (33)
1992-1999 : Etudes de Médecine à l’Université de BORDEAUX II
Obtention du concours de 1ère année en 1994, UB2, UFR II
Obtention du concours de l’internat de spécialité en 1999
1999-2004 : Internat de spécialité en gynécologie-obstétrique au CHRU d’AMIENS (80)
Service du Pr. BOULANGER
Novembre 1999 à novembre 2000 : 2 semestres au CHG de Beauvais (60), Service
du Docteur A. MANELA
Novembre 2000 à Mai 2002 : 3 semestres au Centre de Gynécologie-Obstétrique
du CHU d’Amiens, service du Professeur J.C. BOULANGER (gynécologie
chirurgicale, grossesses pathologiques, urgences/bloc obstétrical/diagnostic
prénatal, Assistance Médicale à la Procréation)
Mai 2002 à Mai 2003 : 2 semestres dans le servie de Chirurgie viscérale et
digestive du Professeur P. VERHAEGUE, au CHU Nord, Amiens
Mai 2003 à novembre 2004 : 3 semestres au Centre de Gynécologie Obstétrique du
CHU d’Amiens, service du Professeur J.C. BOULANGER
(chimiothérapie/pathologie mammaire, bloc obstétrical, bloc chirurgical)
2004-2006 : Chef de clinique –Assistante, Service Pr GRALL, CHU de Rennes
Actuellement : Praticien Contractuel
Diplômes universitaires (DU/DIU):
2002 :
Diplôme universitaire : Colposcopie et Pathologies cervico-vaginales (Pr
Boulanger, Pr Leroy, Pr Quéreux)
Diplôme interuniversitaire : Ultrasonographie en Gynécologie et Obstétrique
(Pr Puech, Lille)
Mémoire de DIU : Hyperéchogénicité intestinale fœtale
2006 :
DU de Grossesses à Haut Risque et Initiation à la Recherche Clinique (CHU
Tenon, Pr Uzan et Dr Berkane, Paris 12)
Mémoire : Les anomalies d’implantation du placenta : placentas accreta,
increta, percreta. Notre expérience depuis 3 ans
DU de Sénologie (CHU Tours, Pr Body)
Consultations :
Consultation d’échographie gynécologique et obstétricale hebdomadaire depuis
2001 au CHU d’Amiens puis de Rennes
Consultation clinique en gynécologie obstétrique hebdomadaire depuis 2001
(gynécologie et obstétrique) au CHU d’Amiens puis de Rennes.
Thèses et publications :
2002 : Mémoire pour le DIU d’Ultrasonographie en Gynécologie-Obstétrique :
Hyperéchogénicité intestinale fœtale
2004 : Mémoire du DES de Gynécologie Obstétrique
Etude des pratiques obstétricales en salle de travail du CHU d’Amiens sur
une période de 10 ans.
Soutenance le 27 septembre 2004
17 Octobre 2003 : Thèse pour le Doctorat en Médecine (diplôme d’état) (Soutenance
publique)
Etude prospective du devenir des fœtus porteurs d’un hygroma colli vus au
centre de Diagnostic Prénatal du CHU d’Amiens entre avril 1993 et décembre
2002. (à propos de 108 cas)
Présenté par le Pr J. Gondry : congrès de médecine fœtale, Morzine 2005.
2006 : Mémoire pour l’obtention du DU de Grossesses à Haut Risque et Initiation à la
Recherche Clinique (CHU Tenon, Pr Uzan et Dr Berkane, Paris 12) Les anomalies
d’implantation placentaire : placentas accreta, increta, percreta. Notre expérience au CHU
de Rennes de 2004 à 2006.
Mémoire pour l’obtention du DU de Sénologie (CHU Tours, Pr Body) prise en
charge thérapeutique d’une tumeur invasive du sein accompagnée de néoplasie
lobulaire.
Articles :
Epidemiology of HPV infection
Boulanger JC, Sevestre H, Bauville E, Ghighi C, Harlicot JP, Gondry J.
Gynecol Obstet Fertil. 2004 Mar; 32(3):218-23.
Un cas rare de douleurs pelvienne aiguë au 3ième trimestre de la grossesse : la
rupture des ligaments larges
Bauville E, Descheemaeker V, Morcel K, Aguillela-Devaud C, Le Nouvel JB, Grall JY,
Levêque L.
Douleurs, 2006, 7,2 : 75-77.
Dépistage et prévention des lésions cervicales utérines : les nouveautés en 2006.
Morcel K, Bauville E, Levêque J.
Preuves et Pratiques, Juin 2006.
Elle saigne avec un stérilet : que faire ?
Morcel K, Bauville E, Levêque J.
30ième journée Nationales du CNGOF, Paris 01-12-2006
Érosion vésicale tardive après pose de TVT®. Bladder erosion few years after
TVT® procedure
F. Quereux, K. Morcel, V. Landréat, E. Bauville, C. Quereux,J. Levêque,
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 36 (2007) 75-77
Infections invasives à Streptococcus pyogenes (streptocoque du groupe A):
recrudescence en maternité au CHU de Rennes.
Camara A1., Isly H2., Le Meur A.1, Bauville E.2, Gautier A.L.1, Bauer M.1, Gougeon A.1,
Minet J.1, Bataillon S.1, Cormier M1, Chapplain J M.1
Congrès national d’hygiène hospitalière 2007.
Quelles recommandations du CNGOF pour le vaccin et le dépistage demain ?
Karine Morcel1, Jean Philippe Harlicot1, Fabrice Foucher1, 2, Jerry Coiffic1, Estelle
Bauville1, Jean Levêque1, 2 .
31èmes Journées Nationales du CNGOF – Paris, 15.12.2007.
Sensitization of ovarian carcinoma cells with zoledronate restores the cytotoxic
capacity of V γ 9V δ 2 T cells impaired by the prostaglandin E2 immunosuppressive
factor: Implications for immunotherapy.
Lavoué V, Cabillic F, Toutirais O, Thedrez A, Dessarthe B, de La Pintière CT, Daniel P,
Foucher F, Bauville E, Henno S, Burtin F, Bansard JY, Levêque J, Catros V, Bouet-
Toussaint F.
Int J Cancer. 2011 Nov 18. doi: 10.1002/ijc.27353. [Epub ahead of print]
[Acquired uterine arteriovenous malformations].
Vandenbroucke L, Morcel K, Bruneau B, Moquet PY, Bauville E, Levêque J, Lavoue V.
Gynecol Obstet Fertil. 2011 Jul-Aug;39(7-8):469-72. Epub 2011 Jul 12. French.
[Medical abortion from 12 through 14 weeks' gestation: a retrospective study
with 126 patients].
Lavoué V, Vandenbroucke L, Grouin A, Briand E, Bauville E, Boyer L, Lemeut P,
Bernard O, Poulain P, Morcel K.
J Gynecol Obstet Biol Reprod (Paris). 2011 Nov;40(7):626-32. Epub 2011 Jul 8. French.
Fertility and pregnancy outcomes following conservative treatment for placenta
accreta.
Sentilhes L, Kayem G, Ambroselli C, Provansal M, Fernandez H, Perrotin F, Winer N,
Pierre F, Benachi A, Dreyfus M, Bauville E, Mahieu-Caputo D, Marpeau L, Descamps P,
Bretelle F, Goffinet F.
Hum Reprod. 2010 Nov;25(11):2803-10. Epub 2010 Sep 10.
Occurrence of endometrial cancer six years after treatment with thermal
balloon ablation (Thermachoice): first case report.
Le Marrec A, Lavoue V, Morcel K, Duval H, Bauville E, Foucher F, Leveque J.
Eur J Obstet Gynecol Reprod Biol. 2010 Jun;150(2):219-20. Epub 2010 Mar 20. No
abstract available.
[Cesarean scar pregnancy: a case report of conservative management].
Maheut L, Seconda S, Bauville E, Levêque J.
J Gynecol Obstet Biol Reprod (Paris). 2010 May;39(3):254-8. Epub 2010 Mar 12. French.
Maternal outcome after conservative treatment of placenta accreta.
Sentilhes L, Ambroselli C, Kayem G, Provansal M, Fernandez H, Perrotin F, Winer N,
Pierre F, Benachi A, Dreyfus M, Bauville E, Mahieu-Caputo D, Marpeau L, Descamps P,
Goffinet F, Bretelle F.
Obstet Gynecol. 2010 Mar;115(3):526-34.
[Multinodular-adenomatoid tumor of the uterus in a patient with a renal
allograft].
Duval H, Rioux-Leclercq N, Bauville E, Al Jaradi M, Burtin F.
Ann Pathol. 2008 Sep;28(4):308-10. Epub 2008 Aug 23. French
Malformations artérioveineuses endo-utérines acquises Acquired uterine
arteriovenous malformations L. Vandenbroucke , K. Morcel , B. Bruneau , P.-Y.
Moquet , E. Bauville , J. Levêque , V. Lavoue ; GYOBFE-2084; No. of Pages 4, 2011.
Acute abdomen emergencies in pregnancy, Vincent Lavoue, Estelle Bauville,
Patrice Poulain ; Imagerie de la Femme (2009) 19, 105—110
Screening for Chlamydia trachomatis Using,Self-Collected Vaginal Swabs at a
Public Pregnancy, Termination Clinic in France: Results of a Screen-and-Treat
Policy; Vincent Lavoue, Laurent Vandenbroucke, Sophie Lorand, Patrick Pincemin,
Estelle Bauville, , Laurence Boyer,Daniel Martin-Meriadec, , Jacques Minet,, Patrice
Poulain, Karine Morcel. Sexually Transmitted Diseases, 2012.
Conséquences de l’obésité maternelle sur le déroulement du travail et sur
l’accouchement ; Pierre-Emmanuel Bouet, Loïc Sentilhes, Estelle Bauville, Sébastien
Madzou, Philippe Gillard, Alain Fournié, Philippe Descamps. La Lettre du
Gynécologue • n° 348-349 - janvier-février 2010
Occurrence of endometrial cancer six years after treatment with thermal balloon
ablation (Thermachoice1): First case report. Aurelie Le Marrec, Estelle Bauville,
Fabrice Foucher, Jean Leveque. EURO-6902; No. of Pages 2
Direction de thèses/mémoires :
Mémoires d’élève Sage femme
Directeur de thèse de médecine générale soutenue le 16/04/2007 : Activité des
urgences gynécologiques, entre le 1ier juillet et le 30 septembre 2005, dans le
Département d’Obstétrique, Gynécologie et Médecine de la Reproduction de
l’Hôpital Sud de Rennes. PY Le Guen
Thèses de spécialités : 2008, 2010 et 2012
Participation aux jurys de mémoires d’élèves sage-femmes
Participation aux jurys d’épreuve clinique pour le DE de Sage-femmes
Communications :
Octobre 2006 : Induction du travail : les interventions médicamenteuses en
Médecine Humaine et extrapolation à la mise bas des truies hyperprolifiques
Congrès vétérinaire porcin : Club Elite (Paris)
Congrès :
Mai 2007 : Participation au Club des Anesthésistes Réanimateurs en
Obstétrique (CARO) : L’accouchement de la patiente obèse et la césarienne sus-
ombilicale
Mai 2007 : Journées du réseau de périnatalogie en Ile et Vilaine : La césarienne
itérative et risques de placenta accreta
Juin 2007 : Journées de gynécologie obstétrique de l’Ouest : la grossesse et
l’accouchement de la patiente obèse.
10 octobre 2007 : Journées du réseau périnatal des Pays de Loire sur l’obésité
et la grossesse
Tarbes, 5 & 6 Octobre 2007,21èmes Journées Pyrénéennes de Gynécologie:
Vaccination HPV : des nouvelles données ; Karine Morcel, Jean-Philippe
Harlicot, Jerry Coiffic, Fabrice Foucher, Estelle Bauville, Jean Levêque
Enseignement :
Quotidien aux internes de spécialité, internes de médecine générale, étudiants
hospitaliers (sémiologie, externes) depuis 2004
Aide à la préparation des différents mémoires de DU ou DIU des internes de
gynécologie- obstétrique ou médecine générale du service
1 fois par trimestre depuis 2004 : séances d’Activité à la Recherche Clinique avec
les étudiants en 5ième année de Médecine
Cours aux Elèves Sages-femmes (2ième, 3ième et 4ième années): 15 heures /an depuis
2004
Aide à la formation des Infirmières de Bloc Opératoire
Expériences professionnelles :
1997, 98 et 99 : Aides-opératoires à la Clinique Bordeaux Nord, Bloc opératoire de
gynécologie
2002 à 2004 : Remplacements : Consultations cliniques et échographiques
Cabinet de gynécologie médicale et obstétrique d’Abbeville (Somme)
Cabinet de gynécologie médicale et obstétrique et Clinique Sainte-Marie à
Cambrai (Nord)
Cabinet de gynécologie médicale et obstétrique à Saint-Quentin (Aisne)
Clinique Sainte-Thérèse (Amiens, Somme)
Cabinet de gynécologie médicale et d’obstétrique à St Malo (Ille et Vilaine)
2003 : Gardes obstétriques et grossesses pathologiques : Clinique Sainte-Thérèse (Amiens,
Somme)
2004 – 2007 : Garde de senior en Gynécologie Obstétrique au CHU de Rennes
Actuellement :
Depuis le 2 novembre 2004 : Praticien Hospitalier au CHRU de Rennes, Service du Pr.
GRALL puis Pr LEVEQUE
Responsable des urgences gynécologiques depuis 2/11/2004
Activité principale en Chirurgie gynécologique
1 vacation échographique gynécologique hebdomadaire
Consultations de Gynécologie et d’Obstétrique
Prise en charge des Interruptions Médicales de Grossesses au CHU Hôpital Sud
Gardes de senior en Gynécologie Obstétrique au CHU de Rennes
... The incidence is estimated to be between 1:800 [2] and 1:2216 pregnancies [3]. Only limited series and case reports have been found in the literature [2][3][4]. ...
... This hypothesis is supported by the relationship between a prior cesarean section for breech presentation and the risk of pregnancy on a cesarean scar. These cesareans are often scheduled, and the less stressed and less mature lower uterine segment may not heal optimally, facilitating ectopic implantation of the embryo [4] Diagnosis is often possible as early as 5 to 6 weeks of amenorrhea, but sometimes diagnosis can be delayed, as reported in our patients. A case of pregnancy on a scar evolving to 35 weeks of amenorrhea was described in 1995 by Herman et al., complicated by massive hemorrhage with major hemostatic disorders (Disseminated Intravascular Coagulation), treated by hemostatic hysterectomy. ...
Pregnancy on Scar: About 3 Cases
Article
Full-text available
  • Oct 2024
Introduction: Pregnancy on a cesarean scar is a rare form of ectopic pregnancy that occurs within the myometrium of a previous cesarean scar. Its incidence is estimated between 1 in 1,800 and 1 in 2,500 pregnancies. This condition poses significant risks, including massive hemorrhage and uterine rupture, due to its often-delayed diagnosis and challenging management. Methods: Authors present three clinical cases of pregnancies on cesarean scars, managed at our maternity ward. Diagnostic and treatment approaches varied, including methotrexate therapy and surgical interventions. Authors analyzed the incidence, diagnostic criteria, and treatment outcomes based on these cases and recent literature. Results: The incidence of pregnancies on cesarean scars in our service was 0.05%. Diagnoses were made through ultrasound, with advanced imaging used when necessary. Treatments included methotrexate and surgical procedures, with success rates comparable to those reported in the literature. Management strategies were adapted to individual patient circumstances. Discussion: The incidence of pregnancies on cesarean scars appears to be increasing. Diagnostic challenges and the potential for severe complications necessitate early detection and tailored treatment strategies. Methotrexate remains a key component of medical management, though surgical options are essential for severe cases. Preventive measures, including early ultrasound screening and scar assessment, are recommended to reduce recurrence risks. Conclusion: Early diagnosis and appropriate management of pregnancies on cesarean scars are crucial to prevent severe outcomes. The increasing frequency of this condition highlights the need for continued research and development of standardized diagnostic and treatment protocols. Ensuring thorough evaluation and individualized care can significantly improve patient outcomes.
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Cesarean scar pregnancy: A clinical case report
Article
Full-text available
  • Jan 2023
Background: Among the different forms of ectopic pregnancy, cesarean scar pregnancy is one of the most uncommon with an estimated incidence of 1/1800 pregnancies. A major risk of massive hemorrhage, it requires active management as soon as it is diagnosed because it can affect the functional prognosis of the patient (hysterectomy) but can also be life-threatening. Different surgical techniques are generally proposed in first intention to patients who no longer wish to have children, who are hemodynamically unstable and/or in case of failure of medical treatment. Case presentation: We hereby report the case of a young 19-year-old patient with no particular medical history, gravida 2 para 1 with a live child born after a cesarean section for fetal heart rhythm abnormalities during labor 5 months earlier and who presented to the emergency room of our structure for the management of a cesarean pregnancy scar diagnosed at 6 weeks of amenorrhea. She was successfully managed with an intramuscular injection of methotrexate. The follow-up was uneventful. Conclusion: The implantation of a pregnancy on a cesarean section scar is becoming more and more frequent. With consequences that can be dramatic, ranging from hysterectomy to life-threatening hemorrhage, clinicians must be familiar with this pathological entity and be prepared for its management. The latter must be rapid and allow, if necessary, the preservation of the patient's fertility. In this sense, conservative medical treatment with methotrexate injections should be proposed as a first-line treatment in the absence of contraindication.
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Grossesse sur cicatrice de césarienne: à propos d’un cas et revue de la littérature
Article
Full-text available
  • Dec 2018
Cesarean-scar pregnancy is a rare form of the ectopic pregnancy which can be life-threatening or threaten patient's functional prognosis due to hemorrhage or early uterine rupture. We report the case of a 23-year old patient with ectopic pregnancy, gravida 3, para 2, with bi-scarred uterus who was diagnosed with cesarean-scar pregnancy due to metrorrhagias at 7 weeks of amenorrhea. Transvaginal ultrasound allowed early diagnosis and treatment was based on conservative therapy. This study and literature review aim to highlight the diagnostic and therapeutic features of this rare disorder whose knowledge can improve prognosis.
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Comparison of three treatment strategies for cesarean scar pregnancy
Article
Full-text available
  • Aug 2017
  • ARCH GYNECOL OBSTET
Purpose: To explore the optimal treatment for cesarean scar pregnancy. Method: In total, 86 women diagnosed with a cesarean scar pregnancy were divided into three groups according to treatment. The human chorionic gonadotrophin (hCG) decline percentage, intraoperative blood loss and success rate were analyzed in Group A [combination of uterine arterial embolization (UAE), local methotrexate (MTX) injection and dilation & curettage (D&C)], Group B (combination of UAE and local MTX injection) and Group C (D&C). Then, the best treatment was carefully analyzed, and recommendations were provided. Results: The success rate was highest in Group A (97.5%) compared with Group B (76%) and Group C (63.15%). The reduction in hCG was greatest in Group A (86.62%, 44.0-99.97%) compared with group B (67.83%, 18.0-98.03%) and Group C (68.21%, 27.0-93.24%). The intraoperative blood loss was lowest in Group A (44.881, 5-200 ml) compared with Group C (224.737, 10-1000 ml). Additionally, we found that the best time to perform D&C in group A depended on the hCG reduction percentage, and a 35% reduction after UAE and local MTX injection could be used as the indicator to perform D&C. Conclusions: The combination of UAE, local MTX injection and D&C for CSP patients is the optimal treatment strategy. A 35% reduction in hCG after UAE and local MTX injection can be recommended as the indicator to perform D&C.
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Application of placement of Foley catheter under the guidance of ultrasound for treatment of bleeding caused by cesarean section pregnancy
Article
  • Nov 2012
Objective: To explore ultrasound-guided placement of Foley catheter in the treatment of bleeding during or after cesarean section incision in complete curettage of uterine cavity. Methods: Seventy-six patients of cesarean section pregnancy underwent complete curettage of uterine cavity. Hemorrhage occurred in all patients, and ultrasound guided placement of Foley catheter was performed. The balloon was filled to press bleeding point, and the bleeding site was observed with real-time ultrasound. When bleeding deteriorated, the balloon was still used, while bleeding stopped, the balloon could be removed safely. The bleeding amount, amount of injected solution, and time of balloon duration were recorded. Results: In 76 cases of cesarean section pregnancy, 35 were embryo sac-like type and 41 were mixed masses. For 35 patients with embryo sac-like type, the bleeding amount during operation was (30.16 ± 5.20)ml, amount of injected solution was (20.11 ± 5.62)ml, and time of balloon duration was (13.37 ± 4.19)h. For 41 patients with mixed masses, the bleeding amount during operation was (85.88 ± 6.81)ml, amount of injected solution was (30.12 ± 9.06)ml, and time of balloon duration was (31.32 ± 8.28)h. Foley catheter was successfully implanted to stop bleeding in all patients, and the prognosis was good. Conclusion: Real-time ultrasound-guided placement of Foley catheter has important application value in treatment of bleeding caused by cesarean section pregnancy.
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[Cesarean scar ectopic pregnancies: Combined modality therapies with uterine artery embolization before surgical procedure.]
Article
  • Feb 2015
To offer a therapeutic management of cesarean scar pregnancies (GSC) in the first trimester of pregnancy with a first approach by uterine artery embolization (UAE) PATIENTS AND METHODS: This study describes seven cases of GSC diagnosed between 2009 and 2013 in the clinic of the University Hospital of the Hospital of Croix-Rousse. We present the symptoms and how imagery has led to the diagnosis and the therapeutic management conducted. The mean gestational age at diagnosis was 9 weeks gestation. There were ongoing pregnancies with cardiac activity present for each patient. An additional MRI was performed in five patients. Five patients were treated with methotrexate injection, two patients received the Mifegyne. All patients then received a selective uterine artery embolization. Finally within 48hours, suction curettage was performed in 6 patients. A patient at 13 WA+1 required a subtotal hysterectomy for placenta accreta. Intra-operative complications were represented by a bladder injury, two bleeding of 1000mL in patients at 13 WA+1 and 12 WA. For the 6 cases of GSC with a gestational age less than 10 WA, average blood loss was less than 500mL. Three patients underwent resection of scar isthmocele confirmed by EVAC. An intrauterine pregnancy was carried to term after care. Cesarean scar pregnancies is a diagnostic and therapeutic challenge, which should be diagnosed as early as soon as possible with care in a medical facility with a uterine artery embolization technical platform. Our protocol combining Mifegyne and methotrexate for termination of pregnancy and uterine artery embolization (UAE) followed by curettage for evacuation of pregnancy allows conservative treatment while minimizing the risk of bleeding (for GSC diagnosed before 10 WA). Copyright © 2015 Elsevier Masson SAS. All rights reserved.
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Diagnostic, traitement et suivi des grossesses implantées sur cicatrice de césarienne
Article
  • Jul 2014
Objectives Cesarean scar pregnancy is a rare entity. This situation may induce uterine rupture and/or a massive life-threatening hemorrhage. The standard treatment is laparotomy surgery, but in situ injections to replace invasive surgery. The objective of this study was to focus on the diagnosis, optimal management and long-term follow-up of the patients. Patients and methods Data from 6 patients with diagnosis of cesarean scar pregnancy between 2007 and 2013 at Lariboisière hospital were retrospectively collected. Results Endovaginal ultrasound succeeded to diagnose all cases. Four patients were treated with in situ injection of methotrexate performing a vaginal way (n = 2) or laparoscopy (n = 2) and two others using systemic injection. One patient was complicated by hemorrhagic shock requiring iterative embolizations. Three patients achieved a new pregnancy, with one recurrent scar pregnancy complicated by massive hemorrhage. Discussion and conclusion Diagnosis and treatment of cesarean scar pregnancies must be done precociously because of high hemorrhage risks. Endovaginal ultrasound is the gold standard exam. Treatment is non-consensual, but methotrexate in situ injection is effective and safer. Monitoring the decrease of HCG levels and ultrasonography supervision of gestational sac size and its vascularization must be performed. Due to the risk of recurrence, any subsequent pregnancy shows a high risk of complications.
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Unforeseen consequences of the increasing rate of cesarean deliveries: Early placenta accreta and cesarean scar pregnancy. A review
Article
  • Mar 2012
This review concentrates on 2 consequences of cesarean deliveries that may occur in a subsequent pregnancy. They are the pathologically adherent placenta and the cesarean scar pregnancy. We explored their clinical and diagnostic as well as therapeutic similarities. We reviewed the literature concerning the occurrence of early placenta accreta and cesarean section scar pregnancy. The review resulted in several conclusions: (1) the diagnosis of placenta accreta and cesarean scar pregnancy is difficult; (2) transvaginal ultrasound seems to be the best diagnostic tool to establish the diagnosis; (3) an early and correct diagnosis may prevent some of their complications; (4) curettage and systemic methotrexate therapy and embolization as single treatments should be avoided if possible; and (5) in the case of cesarean scar pregnancy, local methotrexate- and hysteroscopic-directed procedures had the lowest complication rates.
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Conservative management of a Cesarean scar ectopic pregnancy: A case report
Article
Full-text available
  • Aug 2009
Cesarean scar pregnancy is the rarest kind of ectopic pregnancy. The immediate prognosis depends on the risks associated with uterine rupture and massive bleeding. A 32-year-old woman (gravida 2, para 1) presented with massive vaginal bleeding. A Cesarean scar pregnancy was diagnosed. She was treated by local methotrexate injection, followed by uterine artery embolization. Recurrence of bleeding necessitated two repeat embolizations. Hysteroscopy four months later revealed the presence of a uterine defect within the Cesarean section scar. Cesarean scar pregnancy should be diagnosed and treated as soon as possible to prevent severe complications and spare fertility.
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Cesarean scar pregnancy
Article
  • Apr 2019
Background: A rare, but potentially life-threatening complication of a Cesarean section is a so-called Cesarean scar pregnancy (CSP). This concerns an ectopic pregnancy, where the implantation takes place in a niche of the Cesarean section scar. Case description: We describe the case of a 29-year-old pregnant woman (G5P3), who after a amenorrhoea period of 6 weeks was referred to us by a midwife because the sonography showed an empty uterus. She had previously undergone two Cesarean sections. During transvaginal sonography we observed a small amiotic sac in the Cesarean section scar, lacking a clear heart rhythm. Conclusion: Since there are no general guidelines for the treatment of CSP, a patient-specific approach should be taken to determine optimal management. There is, however, a clear preference to terminate the pregnancy as soon as possible.
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Heterotopic Caesarean scar pregnancy combined with intrauterine pregnancy successfully treated with embryo aspiration for selective embryo reduction: Case report
Article
  • Feb 2004
  • HUM REPROD
Ectopic pregnancy situated in a Caesarean section scar is a rare but potentially life‐threatening event. Because of its rarity, there are no universal treatment guidelines to manage this condition. We report a case of IVF‐induced triplet heterotopic pregnancy of early gestational age that included one Caesarean scar pregnancy diagnosed as early as 6 weeks gestation. Treatment with embryo aspiration under vaginal ultrasonography for selective embryo reduction was given and the concurrent intrauterine twin pregnancy was preserved successfully.
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Cesarean scar ectopic pregnancy
Article
  • May 2006
  • FERTIL STERIL
Bilateral hypogastric artery ligation followed by dilatation and evacuation under laparoscopic guidance was successful in the treatment of an advanced cesarean scar ectopic pregnancy. This case presents images of ultrasound, magnetic resonance imaging, and gross anatomy unique to cesarean scar pregnancy.
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Hysteroscopic management of cesarean scar ectopic pregnancy
Article
  • Jan 2011
  • Year Bk Obstet Gynecol Wom Health
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Laparoscopic management of cervical-isthmic pregnancy: A proposal method
Article
  • Jul 2009
To describe a rare case of a singleton 9-week cervical-isthmic pregnancy (CIP), treated by laparoscopic removal of the ectopic pregnancy and suturing of the uterine site of the ectopic pregnancy with single stitches. Case report. Main general hospital. A 37-year-old woman was admitted for suspected singleton CIP at week 9, following two Cesarean sections. Clinical examination, beta-hCG increase, and transvaginal ultrasonography were used to monitor the suspected diagnosis of an ectopic pregnancy. Following failure of methotrexate administration, surgeons performed a laparoscopy. The CIP removal was performed by laparoscopic incision, enucleating the isthmic mass and suturing the uterine site of the ectopic pregnancy with single stitches. Intraprocedural or postprocedural complications and uterine integrity preservation. Postoperative recovery period was normal, without intraprocedural or postprocedural complications. Uterine integrity was preserved. No further therapeutic interventions were needed in follow-up. In the case of CIP in women interested in minimally invasive treatment, resection of an ectopic pregnancy and suturing of the removal site may be an option to preserve uterine integrity. By improving endosurgical skills, these treatments may be safely proposed avoiding further invasive therapies.
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Hysteroscopic management of cesarean scar ectopic pregnancy
Article
  • Mar 2009
To present our experience with hysteroscopic removal of cesarean scar ectopic pregnancy (CSP) and review the literature on the current management. Retrospective cohort study. A tertiary referral university hospital, Sydney, Australia. Six patients diagnosed with CSP. Four patients were successfully treated with primary hysteroscopic removal of the ectopic pregnancy. Two patients were treated with systemic methotrexate (MTX), which failed; one patient had a subsequent hysteroscopic removal of CSP, and the second had local injection of MTX to the gestational sac. Clinical, serological, and ultrasound data and follow-up for subsequent pregnancies. For the women treated surgically, the median time for the return of betahCG to <5 mIU/mL was 30 days, the mean operative time was 35 minutes, and the mean estimated blood loss was 140 mL. Three pregnancies were achieved: a miscarriage, a term pregnancy that resulted in a live birth, and an ongoing intrauterine pregnancy. The patient who was managed by MTX took 105 days for the betahCG to normalize and had an ongoing hematoma at the site of the CSP that took 247 days to resolve. Hysteroscopic management of CSP offers advantages over local injection with MTX and systemic MTX with a more rapid return to normal betahCG level and reduction in follow-up time.
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Pregnancy in a uterine scar sacculus: an unusual cause of postabortal haemorrhage. A case report
Article
  • Feb 1978
A patient who presented with incomplete abortion developed severe persistent haemorrhage from the genital tract after evacuation of the uterus, as a result of erosion of a major vessel in a sacculus in a previous caesarean section scar. Detection and management of this condition are discussed.
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