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Cesarean Scar Pregnancy

Ultrasound diagnosis

Kinney Hiett

on 27 September 2014

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Transcript of Cesarean Scar Pregnancy

Cesarean Scar Pregnancy
Ultrasound Diagnosis: the Big Picture
Case 1
34 year old
Initial HCG 1171
HCG in 48 hours 1477 (26%)
41 year old G6P5
HCG 748
40 mm right adnexal mass
Admitted for observation
1. Empty uterus with a clearly visualized endometrium.
2. Empty cervical canal.
3. Gestational sac implanted at cervicoisthmic junction.
4. Thinned myometrium between the gestational sac and bladder.
5. Evidence of functional trophoblastic/placental circulation.
6. Presence of embryonic/fetal pole and/or yolk sac.
Blastocyst implants on fibrous scar
Wedge-shaped myometrial defect
Prevalence 1 per 2000 pregnancies
23 yo G2 P1
EGA 6.5 weeks
Vaginal bleeding and pain
BP 100/50 & pulse 120 bpm
Curettage attempted
Scar defect palpated
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HCG in 48 hours 2023 (37%)
Spontaneous miscarriage rate of 44%
Every patient with a previous cesarean who presents with an early first-trimester pregnancy should undergo transvaginal ultrasound to determine the location of the gestational sac.
Recurrence rate 5%
Prior cesarean delivery
Uterine rupture
Massive hemorrhage
Massive transfusion
Adherent placenta
Loss of fertility (hysterectomy)
Damage to bladder
Full transcript