Loading presentation...

Present Remotely

Send the link below via email or IM

Copy

Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.

DeleteCancel

Make your likes visible on Facebook?

Connect your Facebook account to Prezi and let your likes appear on your timeline.
You can change this under Settings & Account at any time.

No, thanks

Cesarean Scar Pregnancy

Ultrasound diagnosis
by

Kinney Hiett

on 27 September 2014

Comments (0)

Please log in to add your comment.

Report abuse

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
1. Pan J, Qian Y, Wang J. Bilateral interstitial pregnancy after in vitro fertilization and embryo transfer with bilateral fallopian tube resection detected by transvaginal sonography. J Ultrasound Med. 2010;29:1829-1832.
2. Ash A, Smith A, Maxwell D. Caesarean scar pregnancy. BJOG. 2007;114:253-263.
3. MA R, S H, M L. Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol. 2006;107:1373-1381.
4. Seow KM, Huang LW, Lin YH, Lin MY, Tsai YL, Hwang JL. Cesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol. 2004;23:247-253.
5. Osborn DA, Williams TR, Craig BM. Cesarean scar pregnancy: sonographic and magnetic resonance imaging findings, complications, and treatment. J Ultrasound Med. 2012;31:1449-1456.
6. Haimov-Kochman R, Sciaky-Tamir Y, Yanai N, Yagel S. Conservative management of two ectopic pregnancies implanted in previous uterine scars. Ultrasound Obstet Gynecol. 2002;19:616-619.
7. Maymon R, Halperin R, Mendlovic S, Schneider D, Herman A. Ectopic pregnancies in a Caesarean scar: review of the medical approach to an iatrogenic complication. Hum Reprod Update. 2004;10:515-523.
8. Maymon R, Svirsky R, Smorgick N, et al. Fertility performance and obstetric outcomes among women with previous cesarean scar pregnancy. J Ultrasound Med. 2011;30:1179-1184.
9. Ben Nagi J, Ofili-Yebovi D, Marsh M, Jurkovic D. First-trimester cesarean scar pregnancy evolving into placenta previa/accreta at term. J Ultrasound Med. 2005;24:1569-1573.
10. Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson CJ. First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment Cesarean section scar. Ultrasound Obstet Gynecol. 2003;21:220-227.
11. Jiang T, Liu G, Huang L, Ma H, Zhang S. Methotrexate therapy followed by suction curettage followed by Foley tamponade for caesarean scar pregnancy. Eur J Obstet Gynecol Reprod Biol. 2011;156:209-211.
12. McKenna DA, Poder L, Goldman M, Goldstein RB. Role of sonography in the recognition, assessment, and treatment of cesarean scar ectopic pregnancies. J Ultrasound Med. 2008;27:779-783.
13. Monteagudo A, Carreno C, Timor-Tritsch IE. Saline infusion sonohysterography in nonpregnant women with previous cesarean delivery: the "niche" in the scar. J Ultrasound Med. 2001;20:1105-1115.
14. Salomon LJ, Fernandez H, Chauveaud A, Doumerc S, Frydman R. Successful management of a heterotopic Caesarean scar pregnancy: potassium chloride injection with preservation of the intrauterine gestation: case report. Hum Reprod. 2003;18:189-191.
15. Fabres C, Aviles G, De La Jara C, et al. The cesarean delivery scar pouch: clinical implications and diagnostic correlation between transvaginal sonography and hysteroscopy. J Ultrasound Med. 2003;22:695-700; quiz 701-2.
16. Timor-Tritsch IE, Monteagudo A, Santos R, Tsymbal T, Pineda G, Arslan AA. The diagnosis, treatment, and follow-up of cesarean scar pregnancy. Am J Obstet Gynecol. 2012;207:44.e1-44.13.
17. Boyle A, Reddy UM. Epidemiology of cesarean delivery: the scope of the problem. Semin Perinatol. 2012;36:308-314.
18. Timor-Tritsch I. E., Monteagudo A., Cali G., Vintzileos A., Viscarello R., Al-Khan A., Zamudio S., Mayberry P, Cordoba M. M. and Dar P.Cesarean scar pregnancy is a precursor of morbidly adherent placenta.Ultrasound Obstet Gynecol. 2014; 44(3):346-53.
19. Moschos E., Wells C. E. and Twickler D. M. Biometric sonographic findings of abnormally adherent trophoblastic implantations on cesarean delivery scars. J Ultrasound Med. 2014; 33(3):475-81.
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%
VEGF
PlGF
O2
Prior cesarean delivery
Uterine rupture
Massive hemorrhage
Massive transfusion
Adherent placenta
Loss of fertility (hysterectomy)
Damage to bladder
Full transcript