Cesarean scar Pregnancy – a retrospective analysis of cases from 2012 to 2021.

Komplikace jizvy po císařském řezu

Abstract

Introduction : With the increasing number of caesarean sections, the number of cesarean scar pregnancies - CSP is also increasing. This is a relatively new entity of ectopic pregnancy which is risky mainly because of its possible association with placenta accreta spectrum. CSP is thought to represent about 6 % of the total number of ectopic pregnancies in all women who have a history of at least one caesarean section. The estimated incidence of CSP is about 1/1688 of all pregnancies and about 1/2000 of all cesarean sections.

Material and Methodology: retrospective analysis of individual cases of cesarean scar pregnancies managed in our health care facility between 2012 and 2021.

Results: in total, we managed 16 cases of pregnancy in a cesarean scar in 15 women. In one woman, we recorded CSP twice. The mean age of the women was 36.6 years (27-41 years). The mean number of caesarean sections was 1.6 (1-3) and gestational week was 7 (4-10). Time since the cesarean section was on average 3.6 years (2-11). The management was methotrexate administration once, hysteroscopic resection once, and primary vacuum aspiration only eleven times,when in two cases we had to attach laparoscopic uterine artery ligation due to postoperative bleeding. Twice we performed primary ligature of uterine arteries before performing vacuum aspiration. In pregnancies above 10 weeks gestation, we observed more bleeding complications requiring surgical management. Bleeding complications were also related to the presence of fetal cardiac action.

Conclusion: early correct diagnosis is essential in the management of CSP. Pregnancies up to 10 weeks of gestation are managed by simple vacuum aspirations under ultrasound guidance. If the pregnancy is above 10 weeks gestation and especially with cardiac action, we add laparoscopic uterine artery ligation before vacuum aspiration. All patients are subsequently advised to undergo laparoscopic resuturing of the lower uterine segment.

Keywords: cesarean scar pregnancy, ultrasound, vacuum aspiration, uterine artery ligation, methotrexate