CESAREAN SCAR PREGNANCY MANAGEMENT: KEY INSIGHTS
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Keywords
Cesarean scar pregnancy (CSP), placentra accreta disorder, Laparotomy with scar excision and repair, Suction and evacuation
Abstract
Introduction: Cesarean scar pregnancy is defined by the full or partial implantation of the gestational sac in the myometrium scar of the uterine incision from a previous cesarean section. The clinical presentation of a CSP is highly variable, with vaginal bleeding being the most common complaint, with or without abdominal pain. CSP can continue to a viable gestational age and can result in placentra accreta disorder.
Materials and Methods: This prospective study was done in department of obstetrics and gynecology SKIMS Soura Srinagar. In our study, we observed 16 cases of cesarean scar pregnancy over a period of 3 years from August 2021 to September 2024. All women attending our antenatal OPD or casualty with history of amenorrhoea, pain abdomen and bleeding per vagina with positive urine pregnancy test, history of previous LSCS and TVS documented caesarean scar pregnancy or intraoperative features suggestive of caesarean scar pregnancy were included in our study.
Results and Observations: A total of 16 cases were taken in our study over a period of 3 years. Maximum number of patients 8 (50%) were in the age group of 25-30 years. 37% of patients were 3rd gravida. Majority of patients 9 (56.2%) had history of previous two LSCS. Majority of patients (43.7%) had gestational age of 8-10 weeks. In our study we observed different treatment options for the same. Laparotomy with scar excision and repair was done in 31.2% of cases followed by laparoscopic scar excision and repair in 18.7%, Systemic MXT in 18.7%, USG guided dilation and evacuation in 12.5%, laparotomy and scar excision and IU tamponade, Suction and evacuation, Suction and evacuation + IU tamponade and Hysteroscopic removal in 6.25% of cases in each.
Conclusion: The first problem is the diagnosis, which is really difficult for clinicians working in the primary care centers. The second and the main problem is the treatment. Efforts should be made to educate clinicians and radiologists to identify features of scar pregnancies and refer them selectively to tertiary centers.
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Ruqiya Rashid
Senior Residents, Department of Obstetrics and Gynecology SKIMS Srinagar Jammu & Kashmir, India.
Nadia Khurshid
Assistant Professor, Department of Obstetrics and Gynecology SKIMS Srinagar Jammu & Kashmir, India.
Saima Wani
Associate Professor, Department of Obstetrics and Gynecology SKIMS Srinagar Jammu & Kashmir, India.
Iflah Akbar
Senior Residents, Department of Obstetrics and Gynecology SKIMS Srinagar Jammu & Kashmir, India.