Cesarean scar pregnancy: presentation of a clinical case and literature review

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Gabija Barkauskaitė1, Gabija Didžiokaitė2, Agnė Marcinkutė3, Gediminas Mečėjus1,3

1Vilnius university, Faculty of Medicine, Vilnius, Lithuania

2Vilnius university hospital Santaros clinics, Vilnius, Lithuania

3Vilnius city clinical hospital, Vilnius, Lithuania

Abstract

Bacground. Pregnancy in the cesarean section scar is one of the rarest forms of ectopic pregnancy accounting for about 6.1% of all ectopic pregnancies in women who have previously had a cesarean section. Removal of the condition can be treated with medication, surgery, or a combination of the two.

Case report. A forty-year-old woman presented to the Emergency Department for lower abdominal pain. A life history marks one pregnancy completed by caesarean section. The pregnancy test was positive. The concentration of human chorionic gonadotropin (hCG) was 1810 IU/l. A vaginal ultrasound performed at the next visit revealed a 1.0 cm diameter gestational sac at the isthmus of the uterus. 5 weeks pregnancy was confirmed, hCG-5391 IU/l. 3 weeks later a transvaginal ultrasound examination revealed a 10 mm diameter echonegative shadow with a thick capsule in the cesarean section site. Caesarean scar pregnancy was diagnosed. Surgical laparoscopy was performed to remove the cesarean scar pregnancy. Within 24 hours after the operation, hCG levels decreased from 5391 to 1189 IU/l.

Conclusion. Minimally invasive intervention laparoscopy is an effective treatment method with a low risk of complications in the case of pregnancy in the cesarean section scar. Universal treatment guidelines could ensure more successful treatment of this condition.

Keywords: ectopic pregnancy, caesarean section, laparoscopy.

Full article

https://doi.org/10.53453/ms.2023.2.8

Cesarean scar pregnancy: presentation of a clinical case and
literature review
Gabija Barkauskaitė
1
, Gabija Didžiokaitė
2
, Agnė Marcinkutė
3
, Gediminas Mečėjus

1
Vilnius university, Faculty of Medicine, Vilnius, Lithuania
2
Vilnius university hospital Santaros clinics, Vilnius, Lithuania
3
Vilnius city clinical hospital, Vilnius, Lithuania
Abstract
Bacground.


Case report.  !"
 #       $     $
%&'()*+,-
.*/#
&' /0+,-#.*
#&
1          2 34   
&'/0)0+,-
Conclusion.5#
,

Keywords:
Journal of Medical Sciences. 22 Feb, 2023 - Volume 11 | Issue 2. Electronic - ISSN: 2345-0592
Medical Sciences 2023 Vol. 11 (2), p. 66-73, https://doi.org/10.53453/ms.2023.2.8
66
Nėštumas cezario pjūvio rande: klinikinio atvejo pristatymas ir
literatūros apžvalga
Gabija Barkauskaitė
1
, Gabija Didžiokaitė
2
, Agnė Marcinkutė
3
, dr. Gediminas Mečėjus

1
Vilniaus universitetas, Medicinos fakultetas, Vilnius, Lietuva
2
Vilniaus universiteto ligoninė Santaros klinikos, Vilnius, Lietuva
3
Vilniaus miesto klinikinė ligoninė, Vilnius, Lietuva
Santrauka
Įvadas. 6789:;8<=#78=>
=#78:=##<#9:;?;#78
;##8=:==#:
Klinikinis atvejis. @8=#7A#8:#:7#
#=77#'97:B
78B#9:;:C#78B
%&'( #: #7 )*>+,-1#< 9 #  
 7   B <C *   #  D ;D
"9/<=78&' /0>+,-<=#
C#:9:;*887
  # "9 78 9:;  # 7 #: 8
9:;C78&7:#:=#
34:&'#:B7:/0#)0>+,-
Išvados. 59:#:#B##:=9#B
789:;:"BD8;#77#D7=B#
#:
Raktažodžiai: #789:;#:
Journal of Medical Sciences. 22 Feb, 2023 - Volume 11 | Issue 2. Electronic - ISSN: 2345-0592
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1. Įvadas
678 9 :;    8
<= # 78 = 8#
7;7=
 :  
#:9:;:%(E
;#7 #  9 
#8<7
:;  :  7 ;7 "7
C B 9= = :
# 78  :  
9:#9:
F   D #  
##:= #D %4( E   7
 = 78 9 :; 
#:=#
 ; A  # #
:9:C
#BC:8==
#: %G)( 7 97 
#  ; #  
A= ##:= #= # #:
 8 #:   =
8<=C%03(
2. Klinikinis atvejis
@8 =  #7 A
#8:#:7 #
 #= 7   
 7   #
797:B
78 B # 9 :;
:C F9  # 
  :#= #= 7
78 : 7 7 #
78    B
  %&'( #:
#7)*+,-6<;7#7
:78#:
:ABC##
4=7#A7#=7
D< 7   
#   
7  7: : <C * 
 D ;D "9 /
<= 78 &'  /0 +,-
6 # 78 97 
 #= #:= 9: 7
88#::ABC
4**  #-  ;8 # 3 78
7#D 4=
 7 7 #7 7 3 
#<#:8:='#7
B;#8
   #= $
7#87C
BC##
#C "9  
  ##:= 6 #:=
9   
78B;
#: C $ 5
**> - #  $7
#8=  #= : %H+'I(
#:  #A A
AC7
*=7D<7:<
7   #  #;= 
#8:  #: 7 #
 #:  # 
  J  7 7
;7#8
#78
Journal of Medical Sciences. 22 Feb, 2023 - Volume 11 | Issue 2. Electronic - ISSN: 2345-0592
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"  3 <= # A
A C   C#
:9:;*
887#%(
 # #:# % ( "9
789:;
1 paveikslas. Vaginalinis ultragarsinis tyrimas:
tuščia gimdos ertmė, gemalinė pūslelė cezario
pjūvio rande
 9= =  
##D#D##C
#8#89:;C
78 K#:  B;7 
7 B7:
 8 ;D   
C#   ## 8
:8#
#D#:
7:+8:
B#7 8 ; 8# 9 :;
:78B9
;:=#8=;8#:=
#  #:# 7 I:
#7 /*  5 # **  #:
I7 B  
   #8
  34   : &'
#:B7:#)0+,-
7:7:#
    #= &'
#:#7+,-
3. Diskusija ir literatūros apžvalga
678 9 :;    8
<=#78=L3
= # 78 := %( C #C
0G)8;#7=
# 78 :=  #
#<#9:;%3(678
9:;:**/
83***#8))=78
:=%(EB#:#=
9:;:=#<#:
8=##8:#
9:%1I( #C * / C
%4(6:G3 #78
:=7:3
 9 :; : %/(
M#788
  #: #7 8#
   
8#:in vitro
%(E=:=7:
  #:# # =
  :C  # 
#= #=  :
C%G(
8    #
78    :
88A
C A  D   
:  A  D 8
;D D %(!# 78
 :   A# B
9: C:A 78 C
K78 ;#7A: #
  B 9:
C:A<C:A78C%(
:  : # 78 =
#C #  A= =
: #   A 
#:C 8 = #=  7 
#C#:#C
Journal of Medical Sciences. 22 Feb, 2023 - Volume 11 | Issue 2. Electronic - ISSN: 2345-0592
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A 8#C %)( 4* <=#
9= # 78 #= 
#<= # = = :<
E:#C#C9D
#DB:
9#:C#A78C%/(
$   :
#:78#9:#
)4 678 9 :; 9
#;#=B=N
8<  7  8# 
# 8<  ## #
 #  
#98L/
#88
;7 %0( 1   
<%O3*-(<B8%L
*/(7#:7#7#
78   # @:
7#7<8#7#87
# #  # 
#  = ##:= #D
%*(
!# 78 # #<  
D  := ##:= #=
##:8$
8 : # # 
:7###:=
:8:%(
678 9 :;    
###7#
' ##   #
##  B A : C
;#D  # 78 #D
C 8 C %3( 5#
8=:=##=
#: #   B
#:#D@:
C378<=3*
4*#78:=E;#7#:
=##=8:=
: 9: %( @
#789 :; 
#  # : 
# :#: #   
%3(@#
   # 7
7#= 78 L ) <= P
&' ## L /*** +,-   
8;778L3%3(
5#  = #97
 #  = C=
C %4( E  ;  B
 :D    :
9 < #:  # 
#76###
 ##:= B 8# #8
6  ; :   <
# #  "B
#:###:8# 
8##%3(#:C
 #BC %0 (   :
9:C %40( %/( 7#
#    
# # #
#
 #7 :  F 8
8= = ;=  : 
#B 3*  # 7
B  8 ;
7# # 3  G := 
:#7##:%(
"7 7  #: 9# 
7 9: # : 
#B  # # :
#  %( M#
# 78 9 :; 
8   9 ;
# A D #;= 99:C 
B#CAA#A
Journal of Medical Sciences. 22 Feb, 2023 - Volume 11 | Issue 2. Electronic - ISSN: 2345-0592
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 C P &' #: B7:C
":#B#:#
# B  # !=
= 8 # # #BC
#:   : B#
#:  # ##:C
%G( M#7 : # #
7#B;
A   # 
: # # %)(
$# #7 :   
# # 78  ;
B B #:  ##:=
9#  # 
#78
8   # 
B =  =
# #A %)( K#7 :
#  #  ;
#:    8
:AA8;D
D %0(K#  7#C
; #N : #7 #
#: ## :   
: # %3*( 5;= :  7#
#  # ##7:
##:96:#7%/*
(B:##:##
%**(77C7D;#D
C :C $# # #
# # #
:##78
8#7B %3*(F7
 : # #
 #:  :  7:
 #: 9# 7
#79:#:
  :   #
7 8 9# 9 %3( "7
9 #  9##
##B
9:  #: 9# 8 
#  ' := 9:
:    8
 # 9#  ;
#   8=
#=:=%33(6:
#:  #  ;
#789:;8
# D  C:C #: 
8<=C%33(5;=:
#:=#
# I: : 8 :=
#  #; #:#C  B#
8:
4. Išvados
@# :  # B 7
#7789:;#
  # B 88;#= 6 
9  8#  #
78
59:#:
# B ##:=9#B
 ; 78 9 :; 
:"BD8;#77#D7=
B#   #:
#= #;   # 7
=##=:=97
==
Literatūros šaltiniai
 16@95116#
 " 5 5 ! 

.N    
?!
3*3*60Q)%(N*)
3 M91@5KMJ@F
R## @ & 1 1 !
Journal of Medical Sciences. 22 Feb, 2023 - Volume 11 | Issue 2. Electronic - ISSN: 2345-0592
71
   1 $N 
,9 &  &
" &  I ' 3*3 H
0Q3*3N))))*0
 J@5'!69M
"!1 & 1 ! N
"  5 & &
3*3Q%4(N44
4 &S ' $ $ +! 
JTJ5?"H
H   I  &  
.N
 , I ' 3*)
HQ/%3(N0UG/
/ '.5@MH$5K1
I I     !.
&
     
N     
'5V+W3*3
53/V3*33533WQ4%*(N
N-----)3
 X K @ @ *N I 
    
J
 I Y ' 3*0 5
Q33*%(N1G)4
G 51!JI
'+3*/"Q/%(NG3U/
) #511J$5
1"&N&
 J65 J 6 5  3*3 5
Q/0%3/(N3))U0
0 M $ K J & 1 !
N"2,&
&!53*3*J/Q4%(N/U)
* &+&&1H1K&
H&
  . : H 
13**)6Q0*%/(N3**/G 3**/*
 5J&&1
!N $ K#"  
& H 5  J H
M3*0"Q%4(N33UG
3 5K1KZ+'5!M
J5!'KZ9J1J&1!
[& 1N $ "
  1  5 $
5%@(3*3)Q/G%4(N3
 5 X 1 5 1 \   #
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  5 %?( 3*G
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%&1!(2K, '+:
5. H  5 V+W
3*3* V 3*33 5 33WQG  N
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     J
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 $  & 1  
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!   , 1
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3 K @ "    @ +
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33 ' 1 ' !1' K

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&!.I'3*Q4%(N3)U*
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