Treatment of ectopic pregnancy implanted on cesarea scar: cohort study 2018-2022, Lima, Peru
DOI:
https://doi.org/10.18597/rcog.3958Keywords:
Cesarean section, ectopic pregnancy, methotrexate, scar, placenta accretaAbstract
Objectives: To describe the clinical characteristics and treatment of ectopic pregnancy arising in the cesarean section scar, as well as its complications and obstetric prognosis.
Material and methods: Retrospective cohort study of pregnant women with the diagnosis of a scar pregnancy in accordance with Maternal-Fetal Medicine Society criteria, seen between January 2018 and March 2022 in two high complexity institutions of the social security system, located in Lima, Peru. Consecutive sampling was used. Baseline sociodemographic and clinical variables were measured, including diagnosis, type of treatment, complications and obstetric prognosis. A descriptive analysis was performed.
Results: Out of 29,919 deliveries, 17 patients were included. Of these, 41.2 % received medical management and the rest were treated surgically. Successful management with intra-gestational sac methotrexate was performed in two patients with ectopic pregnancy type 2. Four patients required total hysterectomy. Six patients became pregnant after the treatment and 4 completed their pregnancy with healthy mother and neonate pairs.
Conclusions: Ectopic pregnancy implanted in a cesarean section scar is an infrequent occurrence for which medical and surgical management options are available with apparently good outcomes. Further studies of better methodological quality and random assignment are needed in order to help characterize the safety and effectiveness of the various therapeutic options for women with suspected scar pregnancy.
Author Biographies
Oswaldo Tipiani-Rodríguez, Hospital Nacional Alberto Sabogal Sologuren - EsSalud, Lima (Perú).
Médico especialista en Ginecología y Obstetricia, Departamento de Gineco Obstetricia, Hospital Nacional Alberto Sabogal Sologuren - EsSalud, Lima (Perú).
José Carlos Elías-Estrada, Hospital Nacional Edgardo Rebagliati Martins - EsSalud, Lima (Perú).
Médico especialista en Ginecología y Obstetricia, Departamento de Gineco Obstetricia, Hospital Nacional Edgardo Rebagliati Martins - EsSalud, Lima (Perú).
Yuliana Libet Bocanegra-Becerra, Hospital Nacional Alberto Sabogal Sologuren - EsSalud, Lima (Perú).
Médico especialista en Ginecología y Obstetricia, Departamento de Gineco Obstetricia, Hospital Nacional Alberto Sabogal Sologuren - EsSalud, Lima (Perú).
Miguel Angel Ponciano-Biaggi, Hospital Nacional Alberto Sabogal Sologuren - EsSalud, Lima (Perú).
Médico especialista en Ginecología y Obstetricia, Departamento de Gineco Obstetricia, Hospital Nacional Alberto Sabogal Sologuren - EsSalud, Lima (Perú).
References
Cunningham, F. Gary, et al. Williams Obstetrics. 25th ed. New York: McGraw-Hill Education; 2018. pp. 237-238.
Society for Maternal-Fetal Medicine (SMFM), Miller R, Gyamfi-Bannerman C, Publications Committee. Society for Maternal-Fetal Medicine Consult Series #63: Cesarean scar ectopic pregnancy. Am J Obstet Gynecol. 2022;227(3):B9-20. https://doi.org/10.1016/j.ajog.2022.06.024
Vial Y, Petignat P, Hohlfeld P. Pregnancy in a cesarean scar. Ultrasound Obstet Gynecol. 2000;16(6):592-3. https://doi.org/10.1046/j.1469-0705.2000.00300-2.x
Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnancies: Etiology, diagnosis, and management. Obstet Gynecol. 2006;107(6):1373-81. https://doi.org/10.1097/01.AOG.0000218690.24494.ce
Tantbirojn P, Crum CP, Parast MM. Pathophysiology of placenta creta: The role of decidua and extravillous trophoblast. Placenta. 2008;29(7):639-45. https://doi.org/10.1016/j.placenta.2008.04.008
Timor-Tritsch IE, Monteagudo A, Cali G, Palacios-Jaraquemada JM, Maymon R, Arslan AA, et al. Cesarean scar pregnancy and early placenta accreta share common histology. Ultrasound Obstet Gynecol. 2014;43(4):383-95. https://doi.org/10.1002/uog.13282
Timor-Tritsch IE, Monteagudo A. Unforeseen consequences of the increas-ing rate of cesarean deliveries: Early placenta accreta and cesarean scar pregnancy. A review. Am J Obstet Gynecol. 2012;207(1):14-29. https://doi.org/10.1016/j.ajog.2012.03.007
Birch Petersen K, Hoffmann E, Rifbjerg Larsen C, Svarre Nielsen H. Ce-sarean scar pregnancy: A systematic review of treatment studies. Fertil Steril. 2016;105(4):958-67. https://doi.org/10.1016/j.fertnstert.2015.12.130
Li J, Li H, Jiang J, Zhang X, Shan S, Zhao X, et al. Dilatation and curettage versus lesion resection in the treatment of cesarean-scar-pregnancy: A sys-tematic review and meta-analysis. Taiwan J Obstet Gynecol. 2021;60(3):412-21. https://doi.org/10.1016/j.tjog.2021.03.006
Soro MAP, Denys A, de Rham M, Baud D. Short & long term adverse out-comes after arterial embolisation for the treatment of postpartum haemor-rhage: a systematic review. Eur Radiol. 2017;27(2):749-62. https://doi.org/10.1007/s00330-016-4395-2
Lipscomb GH, Stovall TG, Ling FW. Nonsurgical treatment of ectopic preg-nancy. N Engl J Med;343(18):1325-9. https://doi.org/10.1056/NEJM200011023431807
Barnhart KT, Gosman G, Ashby R, Sammel M. The medical management of ectopic pregnancy: A meta-analysis comparing "single dose" and "multi-dose" regimens. Obstet Gynecol. 2003;101(4):778-84. https://doi.org/10.1097/00006250-200304000-00028
Herondelle C, Spiers A, Nyangoh-Timoh K, Thubert T, Fauconnier A, Mo-quet PY, et al. Efficacy of in situ methotrexate injection in the treatment of nontubal ectopic pregnancies: A retrospective multicenter study. J Minim Invasive Gynecol. 2022;29(2):243-9. https://doi.org/10.1016/j.jmig.2021.08.007
Peng P, Gui T, Liu X, Chen W, Liu Z. Comparative efficacy and safety of local and systemic methotrexate injection in cesarean scar pregnancy. Ther Clin Risk Manag. 2015;11:137-42. https://doi.org/10.2147/TCRM.S76050
Kaelin Agten A, Cali G, Monteagudo A, Oviedo J, Ramos J, Timor-Tritsch I. The clinical outcome of cesarean scar pregnancies implanted "on the scar" versus "in the niche". Am J Obstet Gynecol. 2017;216(5):510.e1-510.e6. https://doi.org/10.1016/j.ajog.2017.01.019
Salari N, Kazeminia M, Shohaimi S, Nankali AAD, Mohammadi M. Evalua-tion of treatment of previous cesarean scar pregnancy with methotrexate: A systematic review and meta-analysis. Reprod Biol Endocrinol. 2020;18(1):108. https://doi.org/10.1186/s12958-020-00666-0
Morlando M, Buca D, Timor-Tritsch I, Cali G, Palacios-Jaraquemada J, Monteagudo A, et al. Reproductive outcome after cesarean scar pregnan-cy: A systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2020;99(10):1278-89. https://doi.org/10.1111/aogs.13918
Calì G, Timor-Tritsch IE, Palacios-Jaraquemada J, Monteaugudo A, Buca D, Forlani F, et al. Outcome of Cesarean scar pregnancy managed expect-antly: Systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2018;51(2):169-75. https://doi.org/10.1002/uog.17568
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