Ectopic pregnancy in the uterus scar left after cesarean section: a clinical case
https://doi.org/10.17749/2313-7347.2018.12.2.069-075
Abstract
The article describes a rare clinical case of ectopic pregnancy in the uterine scar left after a cesarean section. The case demonstrates the complexity of diagnosing this abnormality and managing such patients. The proposed approach allowed us to diagnose pregnancy in the uterus scar in due time, avoid hysterectomy, and preserve the reproductive organ.
About the Authors
A. N. Rybalka
Medical Academy named after S.I. Georgievsky, Crimean Federal University named after V.I. Vernadsky
Russian Federation
Russian Federation
Rybalka Anatoliy Nikolaevich – MD, Professor, Member of CAS, Head of Department of Obstetrics, Gynecology and Perinatology, S.I. Georgievsky Medical Academy, CFU n.a. V.I. Vernadsky
5/7, bulvar Lenina, Simferopol, Republic of Crimea, 295006
A. N. Sulima
Medical Academy named after S.I. Georgievsky, Crimean Federal University named after V.I. Vernadsky
Russian Federation
Russian Federation
Sulima Anna Nikolaevna – MD, Professor, Department of Obstetrics, Gynecology and Perinatology, S.I. Georgievsky Medical Academy, CFU n.a. V.I. Vernadsky
5/7, bulvar Lenina, Simferopol, Republic of Crimea, 295006
D. А. Beglitse
Medical Academy named after S.I. Georgievsky, Crimean Federal University named after V.I. Vernadsky ;
Medical Academy named after S.I. Georgievsky, Crimean Federal University named after V.I. Vernadsky
Russian Federation
Russian Federation
Beglitse Dmitriy Anatolyevich – PhD, Associate Professor, Department of Obstetrics, Gynecology and Perinatology, S.I. Georgievsky Medical Academy, CFU n.a. V.I. Vernadsky; Chief Physician of CCMH № 1
5/7, bulvar Lenina, Simferopol, Republic of Crimea, 295006,
8, ul. Vorovskogo, Simferopol, Republic of Crimea, 295017
O. A. Mitrofanova
City Clinical Maternity Hospital № 1
Russian Federation
Russian Federation
Mitrofanova Olga Aleksandrovna – Obstetrician-Gynecologist of the Highest Qualification Category, Honored Doctor, Head of Gynecological Department
8, ul. Vorovskogo, Simferopol, Republic of Crimea, 295017
O. S. Latyshev
Medical Academy named after S.I. Georgievsky, Crimean Federal University named after V.I. Vernadsky
Russian Federation
Russian Federation
Latyshev Oleg Sergeevich – Intern, Department of Obstetrics, Gynecology and Perinatology, S.I. Georgievsky Medical Academy, CFU n.a. V.I. Vernadsky
5/7, bulvar Lenina, Simferopol, Republic of Crimea, 295006
I. О. Kolesnikova
Medical Academy named after S.I. Georgievsky, Crimean Federal University named after V.I. Vernadsky
Russian Federation
Russian Federation
Kolesnikova Inna Olegovna – Intern, Department of Obstetrics, Gynecology and Perinatology, S.I. Georgievsky Medical Academy, CFU n.a. V.I. Vernadsky
5/7, bulvar Lenina, Simferopol, Republic of Crimea, 295006
References
1. Miscarriage in early pregnancy: diagnosis and tactics of reference. Clinical recommendations (protocol of treatment). [Vykidysh v rannie sroki beremennosti: diagnostika i taktika vedeniya. Klinicheskie rekomendacii (protokol lecheniya)]. Pis'mo Minzdrava Rossii ot 07.06.2016 № 15-4/10/2-3482. Moskva. 2016: 34 s (in Russian).
2. Rybalka A.N., Pamfamirov Yu.K., Zabolotnov V.A., Kucherenko Yu.A., Anikin S.S. Ectopic pregnancy (Manual for doctors and students). [Vnematochnaya beremennost' (Posobie dlya vrachej i studentov) [Pod red. A.N. Rybalka]. Simferopol': IC KGMU. 2013: 94 s (in Russian).
3. Anikin S.S., Sulima A.N., Zabolotnov V.A., Beglitse D.A., Rybalka A.N. Features of surgical treatment of women with ectopic pregnancy and its effect on reproductive function. [Osobennosti hirurgicheskogo lecheniya zhenshchin s vnematochnoj beremennost'yu i ego vliyanie na reproduktivnuyu funkciyu]. Mezhregional'naya nauchno-prakticheskaya konferenciya «Besplodnyj brak. Vspomogatel'nye reproduktivnye tekhnologii»: tezisy dokladov. Rostov-na-Donu. 2017: 13-20 (in Russian).
4. Fetishcheva L.E., Ushakova G.A., Petrich L.E. Ectopic pregnancy: risk factors, problems of diagnosis, treatment, recovery of fertility. Review. [Vnematochnaya beremennost': faktory riska, problemy diagnostiki, lecheniya, vosstanovleniya fertil'nosti. Obzor.] Mat' i Ditya v Kuzbasse. 2017; 1 (68): 16-24 (in Russian).
5. Sidorenko V.N., Shkrob M.A., Podrezenko E.F. Ectopic pregnancy in the rumen on the uterus after cesarean section [Ektopicheskaya beremennost' v rubce na matke posle operacii kesareva secheniya]. Medicinskij zhurnal. 2017; 2 (60): 134-40 (in Russian).
6. Comprehensive gynecology [Eds. G.M. Lentz, R.A. Lobo, D.M. Gershenson, V.L. Katz]. Philadelphia: Mosby Elsevier. 2012: 1128 р.
7. The main indicators of the obstetricgynecological service in the Russian Federation in 2015. [Osnovnye pokazateli deyatel'nosti akushersko-ginekologicheskoj sluzhby v Rossijskoj Federacii v 2015 godu]. Spravochnik Ministerstva zdravoohraneniya Rossijskoj Federacii. Moskva. 2016: 33 s (in Russian).
8. Belinga E., Mbo A.J., Hanen C. et al. Grossesse sur cicatrice de césarienne: apport de l’échographie dans le diagnostic et la prise en charge. Health Sci Dis. 2014; 15 (2).
9. Birch Petersen K., Hoffmann E., Rifbjerg Larsen C., Svarre Nielsen H. Cesarean scar pregnancy: a systematic review of treatment studies. Fertil Steril. 2016; 105 (4): 958-67.
10. Diagnosis and Management of Ectopic Pregnancy (Green-top Guideline No. 21). RCOG/AEPU Joint Guideline. 2016: 41 р.
11. Winder S.R., Condous G. Ultrasound Diagnosis of Ectopic Pregnancy. AJUM. 2011; 14 (2): 29-33.
12. Health service in Russia. 2015. Statistical collection. [Zdravoohranenie v Rossii. 2015. Statisticheskij sbornik]. Moskva: Rosstat. 2015: 174 s (in Russian).
13. Fylstra D.L. Ectopic pregnancy not within the (distal) fallopian tube: etiology, diagnosis, and treatment. Am J Obstet Gynecol. 2012; 206 (4): 289-8.
14. Lebedev V.A., Shakhlamova M.N., Davydov A.I. Rare forms of ectopic pregnancy. [Redkie formy ektopicheskoj beremennosti]. Trudnyj pacient. 2016; 14 (8-9): 13-8 (in Russian).
15. Rybalka A.N., Anikin S.S., Sulima A.N. Reproductive health of women after endosurgical treatment of tubal pregnancy. [Reproduktivnoe zdorov'e zhenshchin posle endohirurgicheskogo lecheniya trubnoj beremennosti]. Tavricheskij medikobiologicheskij vestnik. 2015; 18 (1): 103-7 (in Russian).
16. Radzinsky V.E. Obstetric aggression. [Akusherskaya agressiya]. Status Praesens. 2011: 688 s (in Russian).
17. Rizk B., Holliday C.P., Owens S., Abuzeid M. Cervical and cesarean scar ectopic pregnancies: Diagnosis and management. Middle East Fertil Society J. 2013; 18 (2): 67-73.
18. Trufanov G.E., Fokin V.A., Ivanov D.O. et al. About ultrasound diagnosis of ectopic pregnancy. [K voprosu ob ul'trazvukovoj diagnostike ektopicheskoj beremennosti]. Byulleten' Federal'nogo centra serdca, krovi i ehndokrinologii im. V.A. Almazova. 2013: 44-53 (in Russian).
19. Rajarshi A., Narayan S., Ketan K. et al. Ectopic Pregnancy in caesarean section scar: A case report. Radiol Case Rep. 2015; 10 (4): 68-71.
20. Elson C.J., Salim R., Rotdar N. et al. Diagnosis and management of ectopic pregnancy. BJOG. 2016; 123: е15-е55.
21. Kelly Collins, Alka Kothari. Catastrophic consequences of a caesarean scar pregnancy missed on ultrasound. Australas J Ultrasound Med. 2015; 18 (4): 150-6.
22. Makukhina Т.B. Characteristics of ultrasound diagnosis and treatment tactics in the management of patients with pregnancy in the rumen after cesarean section. [Osobennosti ul'trazvukovoj diagnostiki i lechebnoj taktiki pri vedenii pacientok s beremennost'yu v rubce posle kesareva secheniya]. Rossijskij elektronnyj zhurnal luchevoj diagnostiki. 2012; 2 (3): 95-9 (in Russian).
23. Sazonova E.O., Ramazanova S.S. Problems in diagnosis of ectopic pregnancy. [Problemy diagnostiki ektopicheskoj beremennosti]. Endoskopicheskaya hirurgiya. 2014; 6: 38-41 (in Russian).
24. Osborn D.A., Williams T.R., Craig B.M. Cesarean scar pregnancy sonographic and magnetic resonance imaging findings, complications, and treatment. J Ultrasound Med. 2012; 31(9): 1449-56.
25. Timor-Tritsch I.E., Monteagudo A. Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accrete and cesarean scar pregnancy. A review. Am J Obstet Gynecol. 2012; 207 (1): 14-29.
26. González de Jesús L.P., Barrera García A. Ectopic pregnancy in cesarean scar. Ginecol Obstet Mex. 2012; 80 (4): 295-9.
27. Chechneva M.A., Panov A.E., Fedorov A.A., Blagina E.I. Possibilities of ultrasound diagnosis and management of pregnancy in the rumen on the uterus. [Vozmozhnosti ul'trazvukovoj diagnostiki i vedeniya beremennosti v rubce na matke]. SonoAce Ultrasound. 2015; 27: 3-10 (in Russian).
28. Lu H.Y., Zhang W.H., Shan J. et al. Study on 31 cases with cesarean scar pregnancy treated by transvaginal surgery. Zhonghua Fu Chan Ke Za Zhi. 2011; 46 (12): 917-22.
29. Seow K.M., Wang P.H., Huang L.W., Hwang J.L. Transvaginal sono-guided aspiration of gestational sac concurrent with a local methotrexate injection for the treatment of unruptured cesarean scar pregnancy. Arch Gynecol Obstet. 2013; 27: 59-62.
Review
For citations:
Rybalka A.N., Sulima A.N., Beglitse D.А., Mitrofanova O.A., Latyshev O.S., Kolesnikova I.О. Ectopic pregnancy in the uterus scar left after cesarean section: a clinical case. Obstetrics, Gynecology and Reproduction. 2018;12(2):69-75. (In Russ.) https://doi.org/10.17749/2313-7347.2018.12.2.069-075
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