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. 2015 Nov 21:13:126.
doi: 10.1186/s12958-015-0120-2.

First-trimester diagnosis and management of Cesarean scar pregnancies after in vitro fertilization-embryo transfer: a retrospective clinical analysis of 12 cases

Yan Ouyang  1   2 , Xihong Li  3 , Yan Yi  4 , Fei Gong  5   6 , Ge Lin  7   8 , Guangxiu Lu  9   10
Affiliations

First-trimester diagnosis and management of Cesarean scar pregnancies after in vitro fertilization-embryo transfer: a retrospective clinical analysis of 12 cases

Yan Ouyang et al. Reprod Biol Endocrinol. .

Abstract

Background: Although Caesarean scar pregnancy (CSP) is rare, it can cause life-threatening complications. The increasing rate of Cesarean delivery plus rapid development of in vitro fertilization-embryo transfer (IVF-ET) may increase the occurrence of CSP as well as the ratio of heterotopic CSP (HCSP)/CSP. Therefore, early diagnosis and management of CSP are necessary to avoid serious complications. And the purpose of this article is to evaluate the importance and feasibility of the first-trimester diagnosis and management of CSP after IVF-ET.

Methods: All the 12 cases were secondary infertility patients who had a history of Cesarean section and underwent IVF-ET in our reproductive center. All cases with CSP were diagnosed using transvaginal color Doppler sonography (TVS). Medical, surgical and expectant managements were implemented, and the management results were traced.

Results: Patients with CSP (n = 12) were diagnosed from January 2011 to April 2015, 6 (50 %) of which were HCSP. The prevalence of CSP was 1:1688 pregnancies. The gestational age ranged from 5 + 3 to 7 + 4 weeks in all CSP, and from 5 + 6 to 7 + 4 weeks in HCSP at diagnosis. Five patients received successful surgical treatment. The success rate of medical and expectant management was 50 % (1/2) and 100 % (5/5), respectively. One patient with failed medical management needed an emergency laparotomy to evacuate CSP. The uterus was preserved in all 12 patients.

Conclusions: The Caesarean section and IVF-ET may increase the ratio of HCSP/CSP. TVS is a noninvasive and effective tool for use in diagnosing CSP. CSP should be carefully excluded in patients who have had a history of Caesarean section. Early diagnosis of CSP in the first trimester may contribute towards the preservation of uterus as well as intrauterine pregnancy (IUP) in HCSP.

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Figures

Fig. 1
Fig. 1
Ultrasound findings of a typical CSP. Longitudinal section of the uterus showing a 6 + 3 weeks with cardiac activity gestational sac (Case 1; crown–rump length:3.6 mm) implanted into a previous Cesarean section scar and protruding towards the urinary bladder with strong peripheral color doppler signals
Fig. 2
Fig. 2
Ultrasound findings of a HCSP. Longitudinal section of the uterus showing the coexistance of an intrauterine pregnancy with a live embryo (F2, crown–rump length:11.1 mm) and a gestational sac with a dead embryo (F1, crown–rump length:3 mm) implanted into the lower segment Cesarean section scar in Case 9 at 7 + 4 weeks
See this image and copyright information in PMC

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