Cesarean scar ectopic pregnancy

Česká verze

Authors: L. Zahálková ¹; M. Kacerovský ²
Authors place of work: Gynekologicko-porodnické oddělení Oblastní nemocnice, Náchod primář MUDr. M. Střecha ¹; Porodnická a gynekologická klinika FN, Hradec Králové přednosta doc. MUDr. J. Špaček, Ph. D. ²
Published in the journal: Ceska Gynekol 2016; 81(6): 414-419

Summary

Objective:
To summarize current knowledge about cesarean scar pregnancy and to provide a review about available managements of this serious pregnancy pathology.

Design:
Review article.

Setting:
Department of Gynecology and Obstetrics, District Hospital Náchod.

Results:
Cesarean scar pregnancy is likely to be a result of impaired healing of the scar along with an increased affinity of trophoblast cells to extracellular matrix. A transvaginal ultrasonography represents a key tool in the cesarean scar pregnancy identification. The main goal of the cesarean scar pregnancy treatment is to preserve fertility. There are different approaches how to manage this pregnancy complication. A surgical treatment is characterized by an exstirpation of ectopic pregnancy. This approach makes a repair of lower uterine segment possible and it may improve a prognosis for subsequent pregnancy. However, the most common management is a conservative treatment with a methotrexate administration. Recently, an innovative mini-invasive treatment with a Foley catheter has been reported. A regular evaluation of βhCG concentrations and a transvaginal ultrasound examination are used for a follow-up. Subsequent pregnancy is possible, yet it should be considered as a high-risk.

Conclusion:
Despite the fact the frequency of cesarean scar pregnancy increases, cesarean scar pregnancy still represents a rare but serious pregnancy pathology. In case of an early diagnosis, it should be managed with respect to preserve fertility.

Keywords:
cesarean section, ectopic pregnancy, methotrexate, fertility

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