Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 14 , ISSUE 2 ( March-April, 2022 ) > List of Articles

ORIGINAL RESEARCH

Cesarean Scar Pregnancy: Diagnostic and Management Dilemmas in Low-resource Settings

Shalini Singh, Amrita Chaurasia, Nidhi Sachan, Neeta Varma

Keywords : Abortifacient, Abortions, Cesarean scar pregnancy, Cohort, Laparotomy

Citation Information : Singh S, Chaurasia A, Sachan N, Varma N. Cesarean Scar Pregnancy: Diagnostic and Management Dilemmas in Low-resource Settings. J South Asian Feder Obs Gynae 2022; 14 (2):166-171.

DOI: 10.5005/jp-journals-10006-2030

License: CC BY-NC 4.0

Published Online: 21-06-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Background: Cesarean scar pregnancy (CSP) is a rare but catastrophic event. The incidence of cesarean section (CS) is on an increasing trend and hence is the incidence of CSP. Failure to diagnose and initiate prompt management of CSP may lead to uterine rupture, massive hemorrhage, and even maternal death. Methods: This study was conducted as a retrospective cohort study in women presenting to the Department of Obstetrics and Gynecology, MLN Medical College and Saket Maternity Nursing Home, Prayagraj, Uttar Pradesh, between January 2017 and February 2021, in which a final diagnosis of cesarean scar pregnancy was made. Comprehensive clinical, laboratory, and radiological data were collected from medical records of nine CSP cases. An analysis of demographic and clinical features with treatment modalities was done including age, gravidity, parity, number of previous CS, history of dilation and evacuation (D&E), history of abortifacient intake, presenting complaints, serum beta-hCG levels, sonographic features, and requirement for blood transfusion. Results: The mean age of patients with a final diagnosis of CSP was 30 ± 4.5 years. The previous history of D&E in this study was seen in 22% of patients. The majority (67%) of cases had one previous CS. The median duration from the last CS was 2 years. Approximately 55% of the patients had their last CS done without going into labor. History of abortifacient intake in present pregnancy was notably present in 67% of the patients. The mean gestational sac diameter in patients was 15.4 ± 4.0 mm. Mean myometrial thickness between the bladder and gestational sac was 2.2 ± 1.18 mm. Vascularity was mild in three and severe in five cases. The mean serum beta-hCG level at presentation was 39891.6 ± 36,305 mIU/mL. The majority, i.e., five out of nine patients were managed surgically by laparotomy with a wedge excision of the scar and trophoblastic tissue followed by uterine repair. Conclusion: High index of suspicion for the prompt and accurate diagnosis of CSP by both the gynecologist and sonologist is the need of the hour.


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