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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...

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Autores principales: Fourie, Hanine, El-Zibdeh, Ahmad, Heppell, Victoria, Granne, Ingrid, Lim, Lee Nai, Supramaniam, Prasanna Raj
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
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.
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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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