ECTOPIC PREGNANCY IN THE SCAR AFTER CESAREAN SECTION
Main Article Content
Abstract
In recent decades, there has been a steady increase in the frequency of operative deliveries performed by cesarean section, which inevitably leads to an increase in the likelihood of long-term risks, including an increase in the frequency of ectopic location of the fetal egg. Tubal localization of the fetal egg is the most common, accounting for up to 95.0 % of all cases. Among the rarer forms are found: ovarian, abdominal, cervical, interstitial, and heterotopic pregnancies. Since 2017, in the clinical recommendations approved by the Russian society of obstetricians and gynecologists and agreed with the Ministry of health of the Russian Federation, the classification of ectopic location of the fetal egg includes pregnancy located in the rumen after cesarean section. According to the literature, the frequency of this type of ectopic pregnancy is 0.15 %. Ultrasound criteria for this disease are thinning of the anterior wall of the uterus in the area of the scar, invasion.
The article presents a clinical case of ectopic pregnancy of rare localization located in the area of the scar after cesarean section. The complexity of timely diagnosis and the risks of pregnancy located in the rumen have been demonstrated. Unstable hemodynamics and the presence of hemorrhagic shock did not allow for organ-preserving treatment. According to absolute indications, the patient underwent an organ-carrying operation (hysterectomy).
Keywords
Article Details
Information about financing and conflict of interests
The authors declare that they have no apparent or potential conflicts of interest related to the publication of this article.
This work is licensed under a Creative Commons Attribution 4.0 License.
How to Cite
References
Betran AP, Torloni MR, Zhang JJ, Gülmezoglu AM. WHO Statement on Caesarean Section Rates. BJOG. 2016; 123(5): 667-670
Strizhakov AN, Davydov AI, Shahlamova MN, Belotserkovtseva LD. Ectopic pregnancy. M.: Medicine, 2001. 215 p. Russian (Стрижаков А.Н., Давыдов А.И., Шахламова М.Н., Белоцерковцева Л.Д. Внематочная беременность. М.: Медицина, 2001. 215 с.)
Guriev TD, Sidororva IS. Ectopic pregnancy. M.: Practical Medicine, 2007. 96 p. Russian (Гуриев Т.Д., Сидорова И.С. Внематочная беременность. М.: Практическая медицина, 2007. 96 с.)
Khan Z, Zanfagnin V, El-Nashar SA, Famuyide AO, Daftary GS, Hopkins MR. Risk Factors, Clinical Presentation, and Outcomes for Abdominal Wall Endometriosis. J Minim Invasive Gynecol. 2017; 24: 478-484
Esterle J, Schieda J. Hemorrhagic heterotopic pregnancy in a setting of prior tubal ligation and re-anastomosis. J of Radiol Case Reports. 2015; 9(7): 38-46
Shehab Q, Kamali H, Glew S. Ruptured heterotopic tube secondary to a spontaneous heterotopic pregnancy in a parous woman with a previous vaginal delivery and history of rare renal anomaly. J Obstet Gynaecol. 2016; 36(4): 538-539
Bataille P, Reynard A, Ducarme G. Spontaneous heterotopic triplets – A review of literature. J Gynecol Obstet Hum Reprod. 2017; 46(8): 657-659
Fetisheva LE, Ushakova GA. Rare forms of ectopic pregnancy. Problems of diagnostics, treatment and restoration of fertility. Russian Bulletin of Obstetrician-Gynecologist. 2017; 17(4): 11-19. Russian (Фетищева Л.Е., Ушакова Г.А. Редкие формы внематочной беременности. Проблемы диагностики, лечения и восстановления фертильности //Российский вестник акушера-гинеколога. 2017; 17(4): 11-19)
Clinical recommendations (treatment Protocol) «Ectopic pregnancy». Letter from the Ministry of health of the Russian Federation dated February 6, 2017 N 15-4/10/2-729. 25. Russian (Клинические рекомендации (протокол лечения) «Внематочная беременность». Письмо МЗ РФ от 6 февраля 2017 г. N 15-4/10/2-729. 25 с.)
Rubina EV, Davydov AI, Strizhakov AN, Shakhlamova MN. Rare forms of ectopic pregnancy: a systemic approach to diagnosis and treatment. Gynecology, Obstetrics and Perinatology. 2018; 17(2): 5-11. Russian (Рубина Е.В., Давыдов А.И., Стрижаков А.Н., Шахламова М.Н. Редкие формы эктопической беременности: системный подход к диагностике и лечению //Вопросы гинекологии, акушерства и перинатологии. 2018. Т. 17, № 2. С. 5-11)
Lebedev VA, Shahlamova MN, Davydov AI. The Rare Forms of Ectopic Pregnancy. Difficult Patient. 2016; 14(8-9): 13-18. Russian (Лебедев В.А., Шахламова М.Н., Давыдов А.И. Редкие формы эктопической беременности //Трудный пациент. 2016. Т. 14, № 8-9. С. 13-18)
Caserta NMG, Bacha AM, Grassiotto OR. Cesarean scar ectopic pregnancy: invasion of the bladder wall detected by magnetic resonance imaging. Radiol Bras. 2017; 50(3): 197-198
Baranovskaya EI. Ectopia of the fetal egg and heterotopic pregnancy. Current issues of obstetrics and gynecology in Belarus. 2018; 4: 9-11. Russian (Барановская Е.И. Эктопия плодного яйца и гетеротопическая беременность //Актуальные вопросы акушерства и гинекологии Белоруссии. 2018. № 4. С. 9-11)
Makukhina TB, Pomortsev AV. Peculiarities of ultrasound diagnostics and treatment tactics in patients with cesarean scar pregnancy. Russian Electronic Journal of Radiology. 2012; 2(3): 95-99. Russian (Макухина Т.Б., Поморцев А.В. Особенности ультразвуковой диагностики и лечебной тактики при ведении пациенток с беременностью в рубце после кесарева сечения //Российский электронный журнал лучевой диагностики. 2012. Т. 2, № 3. С. 95-99)
Seow K-M, Huang L-W, Lin Y-H. Cesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol. 2004; 23(3): 247-253