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Safe Service Delivery of a Complex Early Pregnancy Problem: Caesarean Scar Pregnancy
Caesarean Scar Pregnancy (CSP) is an ectopic pregnancy with implantation into the niche of the uterine scar. We aimed to describe the local management of consecutive cases of CSP to develop a standard operating procedure (SOP). Between December 2019 and June 2022, there were 19,100 maternities. Of t...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9741336/ https://www.ncbi.nlm.nih.gov/pubmed/36498640 http://dx.doi.org/10.3390/jcm11237063 |
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author | Fourie, Hanine El-Zibdeh, Ahmad Heppell, Victoria Granne, Ingrid Lim, Lee Nai Supramaniam, Prasanna Raj |
author_facet | Fourie, Hanine El-Zibdeh, Ahmad Heppell, Victoria Granne, Ingrid Lim, Lee Nai Supramaniam, Prasanna Raj |
author_sort | Fourie, Hanine |
collection | PubMed |
description | Caesarean Scar Pregnancy (CSP) is an ectopic pregnancy with implantation into the niche of the uterine scar. We aimed to describe the local management of consecutive cases of CSP to develop a standard operating procedure (SOP). Between December 2019 and June 2022, there were 19,100 maternities. Of these, 23 were CSPs in 19 patients. Median BMI was 29 (range 20.5–52), median number of Caesarean deliveries (CS) was 2 (range 1–4) and 7/23 (30%) were cigarette smokers. At diagnosis, 9/23 were live pregnancies, 3/23 were retained products of conception (RPOC), 9/23 were pregnancies of uncertain viability (PUV), and 2/23 were non-viable. In six, the initial management was expectant, surgical suction evacuation with transrectal ultrasound guidance in 16, and one had a hysterectomy. The median blood loss was 100 mL (range 50–2000 mL). Two patients (9%) required a blood transfusion. Median hospital stay was 1 day (range 0–4). At follow-up after 10 weeks, no patients had an ongoing haematoma, and one had significant RPOC electing hysterectomy. Eight women were known to have 9 subsequent pregnancies (recurrent CSP n = 4, livebirth n = 2, miscarriage n = 2, tubal ectopic n = 1). Outcomes as rated by low blood loss, short hospital stay, and rare need for further intervention were favorable. Factors associated included prompt ultrasonographic diagnosis, availability of transrectal ultrasound guided surgery, and specialist follow-up, which form the basis of the SOP. |
format | Online Article Text |
id | pubmed-9741336 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-97413362022-12-11 Safe Service Delivery of a Complex Early Pregnancy Problem: Caesarean Scar Pregnancy Fourie, Hanine El-Zibdeh, Ahmad Heppell, Victoria Granne, Ingrid Lim, Lee Nai Supramaniam, Prasanna Raj J Clin Med Article Caesarean Scar Pregnancy (CSP) is an ectopic pregnancy with implantation into the niche of the uterine scar. We aimed to describe the local management of consecutive cases of CSP to develop a standard operating procedure (SOP). Between December 2019 and June 2022, there were 19,100 maternities. Of these, 23 were CSPs in 19 patients. Median BMI was 29 (range 20.5–52), median number of Caesarean deliveries (CS) was 2 (range 1–4) and 7/23 (30%) were cigarette smokers. At diagnosis, 9/23 were live pregnancies, 3/23 were retained products of conception (RPOC), 9/23 were pregnancies of uncertain viability (PUV), and 2/23 were non-viable. In six, the initial management was expectant, surgical suction evacuation with transrectal ultrasound guidance in 16, and one had a hysterectomy. The median blood loss was 100 mL (range 50–2000 mL). Two patients (9%) required a blood transfusion. Median hospital stay was 1 day (range 0–4). At follow-up after 10 weeks, no patients had an ongoing haematoma, and one had significant RPOC electing hysterectomy. Eight women were known to have 9 subsequent pregnancies (recurrent CSP n = 4, livebirth n = 2, miscarriage n = 2, tubal ectopic n = 1). Outcomes as rated by low blood loss, short hospital stay, and rare need for further intervention were favorable. Factors associated included prompt ultrasonographic diagnosis, availability of transrectal ultrasound guided surgery, and specialist follow-up, which form the basis of the SOP. MDPI 2022-11-29 /pmc/articles/PMC9741336/ /pubmed/36498640 http://dx.doi.org/10.3390/jcm11237063 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Fourie, Hanine El-Zibdeh, Ahmad Heppell, Victoria Granne, Ingrid Lim, Lee Nai Supramaniam, Prasanna Raj Safe Service Delivery of a Complex Early Pregnancy Problem: Caesarean Scar Pregnancy |
title | Safe Service Delivery of a Complex Early Pregnancy Problem: Caesarean Scar Pregnancy |
title_full | Safe Service Delivery of a Complex Early Pregnancy Problem: Caesarean Scar Pregnancy |
title_fullStr | Safe Service Delivery of a Complex Early Pregnancy Problem: Caesarean Scar Pregnancy |
title_full_unstemmed | Safe Service Delivery of a Complex Early Pregnancy Problem: Caesarean Scar Pregnancy |
title_short | Safe Service Delivery of a Complex Early Pregnancy Problem: Caesarean Scar Pregnancy |
title_sort | safe service delivery of a complex early pregnancy problem: caesarean scar pregnancy |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9741336/ https://www.ncbi.nlm.nih.gov/pubmed/36498640 http://dx.doi.org/10.3390/jcm11237063 |
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