Caesarean scar ectopic pregnancy: Experience from an Australian tertiary centre.
Aust N Z J Obstet Gynaecol
; 60(3): 330-335, 2020 06.
Article
em En
| MEDLINE
| ID: mdl-31944267
ABSTRACT
BACKGROUND:
Despite the rising incidence of caesarean scar pregnancy (CSP), as yet there are no consensus or evidence-based guidelines for management.AIMS:
To review diagnosis, treatment and management of all women with CSP over a 5 year period at Mater Mothers' Hospital, Brisbane, Australia. MATERIALS ANDMETHODS:
Retrospective cohort study of CSP between 2013-2018. Data reviewed included demographics, presenting symptoms, gestational age, ultrasound findings, human chorionic gonadotrophin levels, treatment success, complications, and if available, subsequent pregnancy outcomes.RESULTS:
Twenty-eight women were treated for CSP during the study period. Initial diagnosis was delayed in ten (36%). Overall success rates of initial treatment were 22/28 (79%). Of the six cases of failed treatment, five had been treated with systemic methotrexate alone. All women requiring further intervention had fetal pole present, and 50% had fetal cardiac activity. Failure rate of systemic methotrexate alone was 5/11 (45%). Eleven women deemed appropriate for conservative management did not require further treatment or experience complications. Nine women had data available for subsequent pregnancies, of whom two developed placenta accreta.CONCLUSION:
This study provides data that may assist in guideline development and decision-making for management of CSP. Conservative management in carefully selected women appeared to be safe. Nearly half of women treated with systemic methotrexate alone required another treatment modality, suggesting a role for intralesional treatment, particularly in the presence of fetal pole ± fetal cardiac activity. More than one in five women with documented subsequent pregnancies were diagnosed with placenta accreta.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Gravidez Ectópica
/
Cesárea
/
Cicatriz
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article