JSMC-10400
CESAREAN SCAR ECTOPIC PREGNANCY IN RELATION TO PREVIOUS OBSTETRICAL HISTORY
Gash Khalid Arif a , and Chro Najmaddin Fattah b
Submitted: 27/5/2022; Accepted: 15/3/2023; Published: 21/3/2023
a Matirnity Teaching Hospital,Directorate of Health of Sulaimani, Kurdistan Region, Iraq
b College of Medicine,Univerist of Sulaimani, Kurdistan Region, Iraq
DOI Link: https://doi.org/10.17656/jsmc.10400
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ABSTRACT
Background
Cesarean scar ectopic pregnancy (CSEP) is the implantation of a gestational sac inside the scar of a previous cesarean section (C/S). CSEP is a life-threatening condition that needs early management.
Objectives
The study aimed to know the associations between CSEP and previous obstetrical history.
Patients and Methods
Twenty-seven women with CSEP who were admitted to the Sulaimani Maternity Teaching Hospital from September 2019 to October 2021 were collected for this cross-sectional study. Complete obstetrical history, clinical features, the interval between the last C/S and CSEP, mode of diagnosis, and types of management were recorded.
Results
The mean of maternal age, gravidity and parity were 32.14±4.63 years (range, 24 to 40 years), 3.73±1.75 (range, 1 to 8) and 2.36±1.33 (range, 1 to 6), respectively. The majority (74.1%) had no significant medical diseases. The mean interval between the last C/S and CSEP was 2.6±1.8 years, and 92.6% complained of vaginal bleeding. The association of gravidity with CSEP presentation was statistically significant. Only 22.2% had a history of one prior C/S alone; however, 74.1, 14.8%, and 3.7% of patients had two, three, and four previous C/Ss, respectively. Besides, the associations of first and second C/Ss with obstetricians’ experience who performed the C/Ss were statistically significant.
Conclusion
The risk of CSEP increases when the frequency of gravidity and previous C/S increases.
KEYWORDS
Cesarean section; Ectopic pregnancy; Scar ectopic.
References
1. Fylstra DL. Ectopic pregnancy not within the (distal) fallopian tube: Etiology, diagnosis, and treatment. Am J Obs Gynecol. 2012;206(4):289–99.
2. Marion LL, Meeks GR. Ectopic pregnancy: History, incidence, epidemiology, and risk factors. Clin Obs Gynecol. 2012;55(2):376–86.
3. Alkatout I, Honemeyer U, Strauss A, Tinelli A, Malvasi A, Jonat W, et al. Clinical Diagnosis and Treatment of Ectopic Pregnancy Ibrahim. Obs Gynecol Surv. 2013;68(8):571–81.
4. Mohapatra I, Samantray SR. Scar Ectopic Pregnancy - An Emerging Challenge. Cureus. 2021;13(7):e16673.
5. Jameel K, Abdul Mannan G, Niaz R, Hayat D. Cesarean Scar Ectopic Pregnancy: A Diagnostic and Management Challenge. Cureus. 2021;13(4):e14463.
6. Shi M, Zhang H, Qi S, Liu W, Liu M, Zhao X, et al. They are identifying risk factors for cesarean scar pregnancy: A retrospective study of 79 cases. Ginekol Pol. 2018;89(4):196–200.
7. Wang Q, Peng HL, He L, Zhao X. Reproductive outcomes after previous cesarean scar pregnancy: Follow up of 189 women. Taiwan J Obs Gynecol. 2015;54(5):551–3.
8. Lincenberg KR, Behrman ER, Bembry JS, Kovac CM. Uterine Rupture with Cesarean Scar Heterotopic Pregnancy with Survival of the Intrauterine Twin. Case Rep Obstet Gynecol. 2016;2016:Article ID 6832094.
9. Zhou XY, Li H, Fu XD. Identifying possible risk factors for cesarean scar pregnancy based on a retrospective study of 291 cases. J Obs Gynaecol Res. 2020;46(2):272–8.
10. Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnancy. Obs Gynecol. 2006;107(6):1373–81.
11. Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson CJ. First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment Cesarean section scar. Ultrasound Obs Gynecol. 2003;21(3):220–7.
12. Seow K, Hwang J, Tsai Y. Ultrasound diagnosis of a pregnancy in a Cesarean section scar. Ultrasound Obs Gynecol. 2001;18(5):547–9.
13. Timor-Tritsch I, Monteagudo A, Cali G, Palacios-Jaraquemada J, Maymon R, Arslan A, et al. Cesarean scar pregnancy and early placenta accreta share common histology. Ultrasound Obs Gynecol. 2014;43:383–95.
14. Shamshirsaz AA, Fox KA, Erfani H, Clark SL, Salmanian B, Baker BWet al. Multidisciplinary team learning in managing the morbidly adherent placenta: outcome improvements over time. Am J Obs Gynecol. 2017;216(6):612.e1-5.
15. Nagi J, Ofili-Yebovi D, Sawyer E, Aplin J, Jurkovic D. Successful treatment of a recurrent Cesarean scar ectopic pregnancy by surgical repair of the uterine defect. Ultrasound Obs Gynecol. 2006;28:855–6.
16. Lee JH, Kwon DH, Ahn KH, Hong SC, Kim T. Concomitant ultrasound-guided intra-gestational sac methotrexate-potassium chloride and systemic methotrexate injection in the recurrent cesarean scar pregnancy. Obs Gynecol Sci. 2016;59(3):245–8.