Cesarean Scar Pregnancy – Case Series from Ahvaz

Document Type : Case Report

Authors

1 Department of Obstetrics & Gynecology. School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

2 Department of Obstetrics & Gynecology. School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

3 Department of Radiolog, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Abstract

Background and Objective: Ectopic pregnancy (EP) in a previous cesarean scar occurs in 1/2000 of pregnancies, accounting 6% among women with cesarean sections. The aim of this study was to assess women with cesarean scar pregnancy (CSP) admitted to Razi hospital in Ahvaz.
Subjects and Methods: In this retrospective study, 15 women with CSP hospitalized from 2006 to 2010 were evaluated. CSP was confirmed by history, clinical features, pregnancy test and ultrasound findings. Pregnant women with EP other than CSP were excluded. All the clinical and laboratory data analyzed by SPSS.
Results: During a 5-year period, 0f 29110 babies 44.5%was born via cesarean section, in which 37% cases born via previous cesarean sections. Among women with previous cesarean sections, 15 (0.31%) cases developed CSP. Out of the 15 cases,12 (80%) had two or more  and 3(20%) had only one a prior cesarean section. The most common clinical features were as follows: vaginal bleeding, abdominal pain, hypovolemic shock and vomiting in 100%, 38%, 36% and 33% , respectively.
Conclusion: All women in reproductive age with uterine bleeding and abdominal pain should be tested for pregnancy. Once pregnancy is established, the site of pregnancy should be detected by ultrasound examination. A high index of suspicion is important for making diagnosis of CSP.CSP is an obstetric emergency.
Sci Med J 2012;10(6):685-692

Keywords


 
1-Chang J, Elam-Evans LD, Berg CJ, Herndon J, Flowers L, Seed KL, et al. Pregnancy related mortality surveillance, United States 1991-1999. MMWR. 2003; 52(2): 1-8.
2-Bour J, Loste J, Fernadez H. Sites of ectopic pregnancy a loyear population – based study of 1800 cases. Hum Repord. 2002; 17(12): 3224 -30.
3-Rotas MA, Habermans S, Levgur M. Cesarean scar pregnancies: Etiology, diagnosis and management. Obstet Gynecol. 2006; 107: 1373- 5.
4-Juavez Ocana SJ, Fajardo Gutierrez A, Perez palacioas G. The trend in pregnancies terminated by a cesarian operation in Mexico 1991-1995. Gynecol Obstet Mex. 1999; 67: 308-18.
5-Wang  W, Long W. Complication of cesarean section: pregnancy on the cicatrix of a previous cesarean section. Chinese  Medical Journal. 2002; 115(2): 242-6.
6-Valleg MT, Pierce JG, Daniel TB. Cesarian scar pregnancy. Imaging and treatment with conservative surgery. Obstet gynecol. 1998; 91: 838-40.
7-Lee CL, Wang GJ, Chao A. Laparoscopic management of an ectopic pregnancy in a previous cesarean section scar. Hum Reprod. 1999; 14: 1234-6.
8-Tan G, Chong YS, Biswas A. Cesaean scar pregnancy: A diagnostic to consider carefully in patients with risk factors. Ann Acad Med Singapore. 2005; 34(2): 216-9.
9-Godin PA, Bassil S, Donnez J. An ectopic pregnancy developing in a previous cesarian section scar. Fertil Sterill. 1997; 67: 398-400.
10-Nanroth F, Foth D, Wilhelm L, Fanchin R. Conservative treatment of ectopic pregnancy in a cesarean section scar with methotroxate: A case report. Eur J Obstet Gynecol Report Biol Biol. 2001; 99: 135-7.
11-Lai YM, Lee JD, Lee CL, Chao A. An ectopic pregnancy embedded in the myometriom of a previous cesarian section scar. Acta Obstet Gynecol Scand. 1995; 74: 573-6.
12-Ayoubi JM, Fanchin  R, Meddoun M. Conservative treatment of complicated cesarian scar pregnancy. Acta Obstet Gynecol Scand. 2001; 80: 469-70.
13-Seow KM, Hwang JL, Tasai YL, Hung LW, Lin YH, Hsieh BC. Subsequent pregnancy outcome after conservative treatment of a previous cesarean scar pregnancy. Acta Obstet Gynecol Scand. 2004; 83(12): 1167-72.
14-Damareg I, Durant-Reville M, Robert Y. Diagnosis of an ectopic pregnancy on a cesarian scar. J Radiol. 1999; 80: 44-6.
15-Herman A, Weinraub Z, Avrech O, Choen VK. Fallow up and out come of isthmic pregnancy located in a previous cesarean section scar. Br J Obstet Gynecol. 1995; 102: 839-41.
16-Roberts H, Kohlenber C, Lanzaron V, Avrench O. Ectopic pregnancy in lower segment uterine scar. Aust N 2 J Obstet Gynecol. 1998; 38: 114-6.
17-Libra S, Ferraro R, Ricotta M, Fotha H. Uterine rupture in hystrectomic cicatrix in the 7th month of pregnancy with section scar . Br J Obstet Gynecol. 1995; 102: 839-41.
18-Kakinoki N. Case of a fetus growing for 8 month on the cicatrix of previous cesarean section in the abdominal cavity. Sanfujinka No Jissai. 1971; 20: 896-9.