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Management of Cesarean Scar Pregnancy: A Single-Institution Retrospective Review

OBJECTIVE: Cesarean scar pregnancy (CSP) is a rare condition that occurs when the pregnancy implants in a cesarean scar. An early diagnosis and a proper management are fundamental to prevent maternal complications. We review and discuss the different treatment employed in our unit to reduce morbidit...

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Autores principales: Giampaolino, P., De Rosa, N., Morra, I., Bertrando, A., Di Spiezio Sardo, A., Zizolfi, B., Ferrara, C., Della Corte, L., Bifulco, G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5859871/
https://www.ncbi.nlm.nih.gov/pubmed/29693012
http://dx.doi.org/10.1155/2018/6486407
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author Giampaolino, P.
De Rosa, N.
Morra, I.
Bertrando, A.
Di Spiezio Sardo, A.
Zizolfi, B.
Ferrara, C.
Della Corte, L.
Bifulco, G.
author_facet Giampaolino, P.
De Rosa, N.
Morra, I.
Bertrando, A.
Di Spiezio Sardo, A.
Zizolfi, B.
Ferrara, C.
Della Corte, L.
Bifulco, G.
author_sort Giampaolino, P.
collection PubMed
description OBJECTIVE: Cesarean scar pregnancy (CSP) is a rare condition that occurs when the pregnancy implants in a cesarean scar. An early diagnosis and a proper management are fundamental to prevent maternal complications. We review and discuss the different treatment employed in our unit to reduce morbidity, preserve fertility, and predict possible complications. METHODS: The reported treatment has been expectant management, operative hysteroscopy approach, and intramuscular injection of 50 mg methotrexate (MTX), followed by cervical dilation and manual vacuum aspiration (D&S) with a Karman cannula under ultrasound guidance, uterine artery embolization (UAE), and manual vacuum aspiration under ultrasound guidance and uterine artery embolization before surgical laparotomic resection. RESULTS: Complications were more frequent in women with a history of three or more cesarean section deliveries and with a myometrial thickness thinner than 2 mm. MTX and D&S treatment appear to be most effective and safe at the early age of pregnancy, while UAE and D&S are related to the highest risk of complication in any age of pregnancy. CONCLUSION: An appropriate preoperative diagnostic evaluation, the identification of cases at higher risk, and those eligible for a conservative treatment are fundamental to reduce complications.
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spelling pubmed-58598712018-04-24 Management of Cesarean Scar Pregnancy: A Single-Institution Retrospective Review Giampaolino, P. De Rosa, N. Morra, I. Bertrando, A. Di Spiezio Sardo, A. Zizolfi, B. Ferrara, C. Della Corte, L. Bifulco, G. Biomed Res Int Clinical Study OBJECTIVE: Cesarean scar pregnancy (CSP) is a rare condition that occurs when the pregnancy implants in a cesarean scar. An early diagnosis and a proper management are fundamental to prevent maternal complications. We review and discuss the different treatment employed in our unit to reduce morbidity, preserve fertility, and predict possible complications. METHODS: The reported treatment has been expectant management, operative hysteroscopy approach, and intramuscular injection of 50 mg methotrexate (MTX), followed by cervical dilation and manual vacuum aspiration (D&S) with a Karman cannula under ultrasound guidance, uterine artery embolization (UAE), and manual vacuum aspiration under ultrasound guidance and uterine artery embolization before surgical laparotomic resection. RESULTS: Complications were more frequent in women with a history of three or more cesarean section deliveries and with a myometrial thickness thinner than 2 mm. MTX and D&S treatment appear to be most effective and safe at the early age of pregnancy, while UAE and D&S are related to the highest risk of complication in any age of pregnancy. CONCLUSION: An appropriate preoperative diagnostic evaluation, the identification of cases at higher risk, and those eligible for a conservative treatment are fundamental to reduce complications. Hindawi 2018-03-05 /pmc/articles/PMC5859871/ /pubmed/29693012 http://dx.doi.org/10.1155/2018/6486407 Text en Copyright © 2018 P. Giampaolino et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Study
Giampaolino, P.
De Rosa, N.
Morra, I.
Bertrando, A.
Di Spiezio Sardo, A.
Zizolfi, B.
Ferrara, C.
Della Corte, L.
Bifulco, G.
Management of Cesarean Scar Pregnancy: A Single-Institution Retrospective Review
title Management of Cesarean Scar Pregnancy: A Single-Institution Retrospective Review
title_full Management of Cesarean Scar Pregnancy: A Single-Institution Retrospective Review
title_fullStr Management of Cesarean Scar Pregnancy: A Single-Institution Retrospective Review
title_full_unstemmed Management of Cesarean Scar Pregnancy: A Single-Institution Retrospective Review
title_short Management of Cesarean Scar Pregnancy: A Single-Institution Retrospective Review
title_sort management of cesarean scar pregnancy: a single-institution retrospective review
topic Clinical Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5859871/
https://www.ncbi.nlm.nih.gov/pubmed/29693012
http://dx.doi.org/10.1155/2018/6486407
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