Human Reproduction, Vol. 19, No. 2, 278-284,
February 2004
© 2004 European Society of Human Reproduction and Embryology
Ectopic pregnancies in Caesarean section scars: the 8 year experience of one medical centre
1 Department of Obstetrics and Gynecology and 2 Institute of Pathology, Assaf Harofe Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
3 To whom correspondence should be addressed at: Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, Zerifin, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. e-mail: intposgr{at}post.tau.ac.il
BACKGROUND: Our aim was to supplement the mostly individual case reports on the rarely occurring and life-threatening condition of ectopic pregnancy developing in a Caesarean section scar. METHODS AND RESULTS: Eight of all the patients treated in our department between 1995 and 2002 had been diagnosed for ectopic pregnancy that developed in a Caesarean section scar. They comprised this case series group. Four of them underwent methotrexate treatment; one had expectant management, one transcervical aspiration of the gestational sac and two by open surgery. All the non-surgically treated women had an uneventful outcome. One underwent a term Caesarean hysterectomy and the other first trimester hysterotomy and excision of the pregnancy located in the scarred uterus. Analysis of all these women’s obstetric history revealed that five of them (63%) had been previously operated because of breech presentation, one had a cervical pregnancy and one had placenta previa. Four of them (50%) had multiple (
2) Caesarean sections. CONCLUSIONS: The women at risk for pregnancy in a Caesarean section scar appear to be those with a history of placental pathology, ectopic pregnancy, multiple Caesarean sections and Caesarean breech delivery. Heightened awareness of this possibility and early diagnosis by means of transvaginal sonography can improve outcome and minimize the need for emergency extended surgery.
Key words: caseseries/methotrexate/pregnancy in scar/transvaginal sonography
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