Document Detail

Late-first-trimester cesarean section scar ectopic pregnancy with placenta increta: a case report.
MedLine Citation:
PMID:  22324271     Owner:  NLM     Status:  In-Process    
BACKGROUND: Cesarean section scar pregnancy is a rare ectopic pregnancy that is difficult to manage due to high risk of uterine rupture and maternal hemorrhage-a risk that increases with gestational age.
CASE: A 21-year-old, gravida 3 para 2 woman was diagnosed at 13.5 weeks' gestation by pelvic ultrasound and magnetic resonance imaging with a cesarean scar ectopic pregnancy and placenta increta. Surgical removal of the pregnancy via exploratory laparatomy with intraoperative use of vasopressin minimized initial blood loss. However, extraction of the placenta increta resulted in uncontrolled bleeding, requiring a supracervical hysterectomy.
CONCLUSION: This is the first case report, to our knowledge, of a late-first-trimester cesarean section scar ectopic pregnancy with placenta increta. Early identification of the ectopic pregnancy may allow for more conservative, nonsurgical management. However, with a more advanced gestational age and placenta increta, surgical management is most appropriate to minimize associated maternal risks. A transverse wedge resection of the implantation site, uterine artery embolization, uterine artery ligation, endovascular balloon catheters, or uterine artery tourniquet may help decrease bleeding during surgical extraction of the pregnancy and placenta increta, and also may prevent a hysterectomy.
Rachael T Overcash; Zareh H Khackician
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of reproductive medicine     Volume:  57     ISSN:  0024-7758     ISO Abbreviation:  J Reprod Med     Publication Date:    2012 Jan-Feb
Date Detail:
Created Date:  2012-02-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0173343     Medline TA:  J Reprod Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  61-4     Citation Subset:  IM    
Department of Obstetrics and Gynecology, INOVA Fairfax Hospital, Falls Church, VA, USA.
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