Korean J Obstet Gynecol.  2010 Oct;53(10):934-939. 10.5468/kjog.2010.53.10.934.

Successful management of cesarean scar pregnancy at 13 weeks of gestation by uterine artery embolization: A case report

• Seok JM
• Moon MJ
• Chang SW
• Lee YM
• Jang JH
• Baek MJ

• KMID: 1453759
• DOI: http://doi.org/10.5468/kjog.2010.53.10.934

Abstract

Cesarean scar pregnancy, in which the pregnancy is implanted at the previous cesarean scar, is a very rare form of ectopic pregnancy. A delay in diagnosis can lead to uterine rupture, massive hemorrhage, and serious maternal morbidity. However, the optimal treatment is unknown. We experienced a case of viable cesarean scar pregnancy diagnosed at 13 weeks of gestation treated with uterine artery embolization and report with a brief of literatures.

Keyword

Cesarean scar pregnancy; Ectopic pregnancy; Uterine artery embolization

MeSH Terms

Cicatrix
Female
Hemorrhage
Pregnancy
Pregnancy, Ectopic
Uterine Artery
Uterine Artery Embolization
Uterine Rupture

Figure

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  Fig. 1 (A) (B) Preprocedural transabdominal ultrasound shows a 13-weeks gestational sac with a fetus having heart beat implanted into a previous cesarean section scar. (C) (D) Preprocedural transvaginal ultrasound shows a discontinuity in the anterior uterine wall when running through the gestational sac.

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  Fig. 2 Preprocedural sagittal T2-weighted MRI shows a 10 cm sized gestational sac and fetus with 7.2 cm sized CRL, implanted into a previous cesarean section scar. MRI: magnetic resonance imaging, CRL: crownrump length.

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  Fig. 3 (A) After 11 days, transabdominal ultrasound shows decreased gestational sac to 4.5×6.5 cm without fetal heart beat. (B) 4 month later, transvaginal ultrasound shows hypoechoic defect at the previous cesarean section site, there is no another abnormal lesion.

Reference

1. Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson CJ. First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment Cesarean section scar. Ultrasound Obstet Gynecol. 2003. 21:220–227.

2. Seow KM, Huang LW, Lin YH, Lin MY, Tsai YL, Hwang JL. Cesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol. 2004. 23:247–253.

3. Parente JT, Ou CS, Levy J, Legatt E. Cervical pregnancy analysis: a review and report of five cases. Obstet Gynecol. 1983. 62:79–82.

4. Seow KM, Hwang JL, Tsai YL. Ultrasound diagnosis of a pregnancy in a Cesarean section scar. Ultrasound Obstet Gynecol. 2001. 18:547–549.

5. Lee DH, Cho JS. Clinical analysis of intramural pregnancy. Korean J Obstet Gynecol. 2004. 47:856–862.

6. Vial Y, Petignat P, Hohlfeld P. Pregnancy in a cesarean scar. Ultrasound Obstet Gynecol. 2000. 16:592–593.

7. Roth G, Kleinstein J, Kuhnert A, Kunzel W. Nuclear magnetic resonance imaging of a patient with an ectopic pregnancy. Gynecol Obstet Invest. 1987. 23:135–140.

8. Wright AR, English PT, Cameron HM, Wilsdon JB. MR pelvimetry: a practical alternative. Acta Radiol. 1992. 33:582–587.

9. Fylstra DL. Ectopic pregnancy within a cesarean scar: a review. Obstet Gynecol Surv. 2002. 57:537–543.

10. Ha HK, Jung JK, Kang SJ, Koong SE, Kim SJ, Kim JY, et al. MR imaging in the diagnosis of rare forms of ectopic pregnancy. AJR Am J Roentgenol. 1993. 160:1229–1232.

11. Chou MM, Hwang JI, Tseng JJ, Huang YF, Ho ES. Cesarean scar pregnancy: quantitative assessment of uterine neovascularization with 3-dimensional color power Doppler imaging and successful treatment with uterine artery embolization. Am J Obstet Gynecol. 2004. 190:866–868.

12. Chuang J, Seow KM, Cheng WC, Tsai YL, Hwang JL. Conservative treatment of ectopic pregnancy in a caesarean section scar. BJOG. 2003. 110:869–870.

13. Hong JH, Jeong YA, Hwang JH, Kim JW, Lee KJ, Kim CH, et al. A case of successful treatment of an ectopic pregnancy embedded in the myometrium of previous cesarean section scar with systemic methotrexate injection. Korean J Obstet Gynecol. 2002. 45:1645–1648.

14. Kim HJ, Lee KS, Han MY, Lee EH, Choi WY. Conservative management of intramural pregnancy implanting in the cesarean section scar. Korean J Obstet Gynecol. 2004. 47:1743–1747.

15. Lee KS, Choi YM, Choi YS, Kim JY, Lee SH, Jee BC, et al. A case of ectopic pregnancy in a previous cesarean scar. Korean J Obstet Gynecol. 2005. 48:2723–2728.

16. Ruano R, Kondo MM, Bunduki V, Rodeck C, Zugaib M. Follow-up of uteroplacental vascularization after feticide in third-trimester therapeutic termination of pregnancy with complete placenta previa. Ultrasound Obstet Gynecol. 2006. 27:463–465.

17. Lobel SM, Meyerovitz MF, Benson CC, Goff B, Bengtson JM. Preoperative angiographic uterine artery embolization in the management of cervical pregnancy. Obstet Gynecol. 1990. 76:938–941.

18. Spies JB, Ascher SA, Roth AR, Kim J, Levy EB, Gomez-Jorge J. Uterine artery embolization for leiomyomata. Obstet Gynecol. 2001. 98:29–34.

19. Dutton S, Hirst A, McPherson K, Nicholson T, Maresh M. A UK multicentre retrospective cohort study comparing hysterectomy and uterine artery embolisation for the treatment of symptomatic uterine fibroids (HOPEFUL study): main results on medium-term safety and efficacy. BJOG. 2007. 114:1340–1351.

20. Edwards RD, Moss JG, Lumsden MA, Wu O, Murray LS, Twaddle S, et al. Uterine-artery embolization versus surgery for symptomatic uterine fibroids. N Engl J Med. 2007. 356:360–370.