EC Gynaecology

Pregnancy implanted on a cesarean scar is a rare form of ectopic pregnancy that can be life-threatening and functionally threatening to the patient due to bleeding or early uterine rupture. The increased vigilance of obstetricians-gynecologists for diagnostic ultrasound, which remains the first-line examination, is evidenced by the increases in incidence and cases published over the last decade, reducing morbidity and mortality in this entity. and by providing opportunities for patients to benefit from therapeutic advances without there being a consensus on treatment. Through our illustrative observation and review of the literature, we will update our knowledge on the conditions associated with the incidence of this iatrogenic event, the difficulties of early diagnosis and the challenges of treatment.

 Keywords: Ectopic Pregnancy; Cesarean Section Scar; Obstetric Emergency

1. Belinga E., et al. “Grossesse sur cicatrice de césarienne: apport de l'échographie dans le diagnostic et la prise en charge”. Health Sciences and Disease 2 (2014).
2. Timor-Tritsch IE and Monteagudo A. “Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy. A review”. American Journal of Obstetrics and Gynecology 1 (2012): 14-29.
3. Rotas MA., et al. “Cesarean scar ectopic pregnancies: etiology, diagnosis and management”. Obstetrics and Gynecology6 (2006): 1373-1381.
4. Riethmuller D., et al. “Prise en charge de la grossesse extra-utérine: les autres ectopies (cervicales et abdominales)” (2003).
5. Thouveny A. “Grossesses extra utérines de localisations rares: à propos de 28 cas. Analyse des pratiques et proposition de protocoles thérapeutiques pour la Maternité Régionale Universitaire de Nancy”. Université de Lorraine (2013).
6. Jannet D and Jerbi M. “Utérus cicatricial”. In: cabrol D, Pons J-C, Goffinet F, editors. Traité d’obstétrique. Paris: Flammarion Médecine-Sciences (2003): 337-345.
7. Seow KM., et al. “Caesarean scar pregnancy: issues in management”. Ultrasound in Obstetrics and Gynecology3 (2004): 247-253.
8. Fylstra DL. “Ectopic pregnancy within a caesarean scar: a review”. Obstetrical and Gynecological Survey 8 (2002): 537-543.
9. Maymon R., et al. “Ectopic pregnancies in a caesarean scar: review of the medical approach to an iatrogenic complication”. Human Reproduction Update 6 (2004): 515-523.
10. Ash A., et al. “Caesarean scar pregnancy”. BJOG: An International Journal of Obstetrics and Gynaecology3 (2007): 253-263.
11. Miller DA., et al. “Clinical risk factors for placenta praevia - placenta accreta”. American Journal of Obstetrics and Gynecology 1 (1997): 210-214.
12. Jurkovic D., et al. “First-trimester diagnosis of pregnancy implanted into the lower uterine segment cesarean section scar”. Ultrasound in Obstetrics and Gynecology3 (2003): 220-227.
13. Larsen JV and Solomon MH. “Pregnancy in a uterine scar sacculus-an unusual cause of postabortal hemorrhage”. South African Medical Journal 4 (1978): 142-143.
14. Riethmuller D., et al. “Prise en charge de la grossesse extra-utérine: les autres ectopies (cervicales et abdominales)”. Journal de Gynécologie Obstétrique et Biologie de la Reproduction 32 (2003): 101-108.
15. VShih JC. “Cesarean scar pregnancy: diagnosis with three-dimensional (3D) ultrasound and 3D power Doppler”. Ultrasound in Obstetrics and Gynecology 3 (2004): 306-307.
16. Godin PA., et al. “An ectopic pregnancy developing in a previous caesarean section scar”. Fertility and Sterility 2 (1997): 398-400.
17. Chetty M and Elson J. “Treating non-tubal ectopic pregnancy”. Best Practice and Research Clinical Obstetrics and Gynaecology 4 (2009): 529-538.
18. Thouveny A. “Grossesses extra utérines de localisations rares: à propos de 28 cas. Analyse des pratiques et proposition de protocoles thérapeutiques pour la Maternité Régionale Universitaire de Nancy”. hal01734374, version 1 (2013).