Authors
1 Assistant Professor, obstetrics and gynecology department, Isfahan medical science school, Isfahan, Iran.
2 Professor, fellowship of infertility, obstetrics and gynecology department, Isfahan medical science school, Isfahan, Iran
Abstract
Introduction: caesarian scar pregnancy became a worrisome obstetric problem as a side effect of rising number of caesarian sections these days. Furthermore, from the challenge of diagnosis in case of low suspicious in the initial prenatal sonographic screening, there is remaining debate of the standard of management. According to rare reported cases, the most acceptable recommendation still is termination of pregnancy to decrease the chance of further maternal dreadful complication.
Material and method: here we assumed to explain a rare case of scar-pregnancy with fortunate outcome.
Result: A case of twin pregnancy had been terminated in gestational age of 34 weeks in a tertiary care center with history of first trimesters diagnosis of caesarian scar pregnancy, who had decided to continue pregnancy under close follow-up.
Conclusion: Since pregnancy at the site of a previous cesarean section is very rare, but due to the complications of this type of pregnancy, choosing a suitable clinical approach for these patients is desirable.
This type of pregnancy can increase the value of antenatal care if it can be continued until the fetus is viable and its complications, including placenta accreta and bleeding, are managed.
Keywords
- References: 1. Timor-Tritsch IE, Monteagudo A, Cali G, Vintzileos A, Viscarello R, Al-Khan A, et al. Cesarean scar pregnancy is a precursor of morbidly adherent placenta. Ultrasound Obstet Gynecol. 2014 Sep 1;44(3):346–53. 2. Timor-Tritsch IE, Monteagudo A. Unforeseen consequences of the increasing rate of cesarean deliveries: Early placenta accreta and cesarean scar pregnancy. A review. Am J Obstet Gynecol. 2012 Jul;207(1):14–29. 3. Hasanzadeh M, Baradaran Khalkhale M, Behroznia A. Presentation of a Previous Cesarean Scar Ectopic Pregnancy with Hypovolemic Shock. J Obstet Gynecol Cancer Res. 2017;2(2):0–0. 4. I T-T, D B, D DM, G C, A D, A M, et al. Outcome of cesarean scar pregnancy according to gestational age at diagnosis: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol [Internet]. 2021 Mar 1 [cited 2021 Aug 17];258:53–9. Available from: https://pubmed.ncbi.nlm.nih.gov/33421811/ 5. Tamada S, Masuyama H, Maki J, Eguchi T, Mitsui T, Eto E, et al. Successful pregnancy located in a uterine cesarean scar: A case report. Case Reports Women’s Heal. 2017 Apr 1;14:8–10. 6. N Z, J F, H S, J J, JA R. Natural history of early first-trimester pregnancies implanted in Cesarean scars. Ultrasound Obstet Gynecol [Internet]. 2015 Sep 1 [cited 2021 Oct 8];46(3):367–75. Available from: https://pubmed.ncbi.nlm.nih.gov/25586877/ 7. Roy MM, Radfar F. Management of a Viable Cesarean Scar Pregnancy: A Case Report. Oman Med J [Internet]. 2017 Mar 1 [cited 2021 Aug 17];32(2):161. Available from: /pmc/articles/PMC5397077/ 8. Jungkman O, Anderson J. Importance of early detection of cesarean scar ectopic pregnancy. J Diagnostic Med Sonogr. 2015 Sep 19;31(5):318–21. 9. Pędraszewski P, Wlaźlak E, Panek W, Surkont G. Cesarean scar pregnancy – a new challenge for obstetricians. J Ultrason. 2018 Mar 30;18(72):56–62. 10. Birch Petersen K, Hoffmann E, Rifbjerg Larsen C, Nielsen HS. Cesarean scar pregnancy: A systematic review of treatment studies. Fertil Steril. 2016 Apr 1;105(4):958–67. 11. Yu H, Luo H, Zhao F, Liu X, Wang X. Successful selective reduction of a heterotopic cesarean scar pregnancy in the second trimester: a case report and review of the literature. BMC Pregnancy Childbirth 2016 161 [Internet]. 2016 Nov 29 [cited 2021 Aug 17];16(1):1–7. Available from: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-1171-x 12. Kim M La, Jun HS, Kim JY, Seong SJ, Cha DH. Successful full-term twin deliveries in heterotopic cesarean scar pregnancy in a spontaneous cycle with expectant management. J Obstet Gynaecol Res [Internet]. 2014 May 1 [cited 2022 May 26];40(5):1415–9. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/jog.12326 13. ML Kim HJJKSSDC. Successful full-term twin deliveries in heterotopic cesarean scar pregnancy in a spontaneous cycle with expectant management. J Obs Gynaecol Res. 2014;40(5):1415–9.
)