Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Cesarean Scar Ectopic Pregnancy: Treatment Decision Algorithm and Success With Medical Treatment

Version 1 : Received: 17 March 2021 / Approved: 19 March 2021 / Online: 19 March 2021 (09:01:42 CET)

A peer-reviewed article of this Preprint also exists.

Morente, L.S.; León, A.I.G.; Reina, M.P.E.; Herrero, J.R.A.; Mesa, E.G.; López, J.S.J. Cesarean Scar Ectopic Pregnancy—Case Series: Treatment Decision Algorithm and Success with Medical Treatment. Medicina 2021, 57, 362. Morente, L.S.; León, A.I.G.; Reina, M.P.E.; Herrero, J.R.A.; Mesa, E.G.; López, J.S.J. Cesarean Scar Ectopic Pregnancy—Case Series: Treatment Decision Algorithm and Success with Medical Treatment. Medicina 2021, 57, 362.

Journal reference: Medicina 2021, 57, 362
DOI: 10.3390/medicina57040362

Abstract

Background Cesarean scar ectopic pregnancies are a rare form of extrauterine pregnancies, yet their incidence has increased along with the rise in the number of cesarean deliveries. As with other ectopic pregnancies, cesarean scar ectopic pregnancies pose a greater risk for maternal hemorrhage and ultimately maternal mortality. Case presentation We present a series of clinical cases of cesarean scar ectopic pregnancy diagnosed by transvaginal ultrasonography. Each patient received an individualized treatment: the rate of success depended on the particular maternal condition in each case. Due to the low frequency of this entity, there are no clear protocols for its treatment and thus there are numerous options for treatment and follow up: expectant management, medical therapy, surgical intervention, uterine artery embolization or a combined approach. Each method has different levels of success and is dependent on the surgeon’s skill and patient presentation. The transvaginal ultrasound is necessary to obtain the fine details of the gestation sac and its relation to the scar and must be followed by a meticulous abdominal scan with a full bladder. Conclusion Herein, we present a rare pathological phenomenon whose frequency is on the rise, and for which transvaginal ultrasound and flow doppler provide high diagnostic accuracy. Early diagnosis of cesarean scar ectopic pregnancies offers treatment options to that may help avoid uterine rupture and bleeding, thus preserving the uterus and future fertility.

Keywords

cesarean scar; ectopic pregnancy

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