Recurrent Cesarean scar pregnancy: case series and literature review

I E Timor-Tritsch, G Horwitz, F D'Antonio, A Monteagudo, E Bornstein, J Chervenak, L Messina, M Morlando, G Cali, I E Timor-Tritsch, G Horwitz, F D'Antonio, A Monteagudo, E Bornstein, J Chervenak, L Messina, M Morlando, G Cali

Abstract

Objectives: To determine the rate of recurrent Cesarean scar pregnancy (CSP) in our clinical practices and to evaluate whether the mode of treatment of a CSP is associated with the risk of recurrent CSP, as well as to review the published literature on recurrent CSP.

Methods: We performed a retrospective search of our six obstetric and gynecological departmental ultrasound databases for all CSPs and recurrent CSPs between 2010 and 2019. We extracted various data, including number of CSPs with follow-up, number of cases attempting and number achieving pregnancy following treatment of CSP and number of recurrent CSPs, as well as details of the treatment of the original CSP. After analyzing the clinical data, we evaluated whether the mode of treatment terminating the previous CSP was associated with the risk of recurrent CSP. We also performed a PubMed search for: 'recurrent Cesarean scar pregnancy' and 'recurrent Cesarean scar ectopic pregnancy'. Articles were reviewed for year of publication, and extraction and analysis of the same data as those obtained from our departmental databases were performed.

Results: Our database search identified 252 cases of CSP. The overall rate of clinical follow-up ranged between 71.4% and 100%, according to treatment site (mean, 90.9%). Among these, 105 women had another pregnancy after treatment of the previous CSP. Of these, 36 (34.3%) pregnancies were recurrent CSP, with 27 women having a single recurrence and three women having multiple recurrences, one with two, one with three and one with four. We did not find any particular single or combination treatment mode terminating the previous CSP to be associated with recurrent CSP. The literature search identified 17 articles that yielded sufficient information for us to evaluate their reported prevalence of recurrent CSP. These reported 1743 primary diagnoses of CSP, of which 944 had reliable follow-up. Data were available for 489 cases that attempted to conceive again after treatment of a previous CSP, and on the 327 pregnancies achieved. Of these, 67 (20.5%) were recurrent CSP.

Conclusions: On the basis of our pooled clinical data and review of the literature, recurrent CSP is apparently more common than was previously assumed based upon mostly single-case reports or series with few cases. This should be borne in mind when counseling patients undergoing treatment for CSP regarding their risk of recurrence. We found no obvious causal relationship or association between the type of treatment of the previous CSP and recurrence of CSP. Patients who become pregnant after treatment of a CSP should be encouraged to have an early (5-7-week) first-trimester transvaginal scan to determine the location of the gestation. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Keywords: CSP; Cesarean scar pregnancy; scar pregnancy; ultrasound.

© 2021 International Society of Ultrasound in Obstetrics and Gynecology.

References

REFERENCES

    1. Vial Y, Petignat P, Hohlfeld P. Pregnancy in a cesarean scar. Ultrasound Obstet Gynecol 2000; 16: 592-593.
    1. Timor-Tritsch IE, Monteagudo A. Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy. A review. Am J Obstet Gynecol 2012; 207: 14-29.
    1. Seow KM, Hwang JL, Tsai YL, Huang LW, Lin YH, Hsieh BC. Subsequent pregnancy outcome after conservative treatment of a previous cesarean scar pregnancy. Acta Obstet Gynecol Scand 2004; 83: 1167-1172.
    1. Hasegawa J, Ichizuka K, Matsuoka R, Otsuki K, Sekizawa A, Okai T. Limitations of conservative treatment for repeat Cesarean scar pregnancy. Ultrasound Obstet Gynecol 2005; 25: 310-311.
    1. Ben Nagi J, Ofili-Yebovi D, Sawyer E, Aplin J, Jurkovic D. Successful treatment of a recurrent Cesarean scar ectopic pregnancy by surgical repair of the uterine defect. Ultrasound Obstet Gynecol 2006; 28: 855-856.
    1. Ben Nagi J, Helmy S, Ofili-Yebovi D, Yazbek J, Sawyer E, Jurkovic D. Reproductive outcomes of women with a previous history of Caesarean scar ectopic pregnancies. Hum Reprod 2007; 22: 2012-2015.
    1. Maymon R, Svirsky R, Smorgick N, Mendlovic S, Halperin R, Gilad K, Tovbin J. Fertility performance and obstetric outcomes among women with previous cesarean scar pregnancy. J Ultrasound Med 2011; 30: 1179-1184.
    1. Nguyen-Xuan HT, Lousquy R, Barranger E. [Diagnosis, treatment, and follow-up of cesarean scar pregnancy]. Gynecol Obstet Fertil 2014; 42: 483-489.
    1. Yamaguchi M, Honda R, Uchino K, Tashiro H, Ohba T, Katabuchi H. Transvaginal methotrexate injection for the treatment of cesarean scar pregnancy: efficacy and subsequent fecundity. J Minim Invasive Gynecol 2014; 21: 877-883.
    1. Yu XL, Zhang N, Zuo WL. [Cesarean scar pregnancy: an analysis of 100 cases]. Zhonghua Yi Xue Za Zhi 2011; 91: 3186-3189.
    1. Wang Q, Peng HL, He L, Zhao X. Reproductive outcomes after previous cesarean scar pregnancy: Follow up of 189 women. Taiwan J Obstet Gynecol 2015; 54: 551-553.
    1. Gao L, Huang Z, Zhang X, Zhou N, Huang X, Wang X. Reproductive outcomes following cesarean scar pregnancy - a case series and review of the literature. Eur J Obstet Gynecol Reprod Biol 2016; 200: 102-107.
    1. Bennett TA, Morgan J, Timor-Tritsch IE, Dolin C, Dziadosz M, Tsai M. Fifth recurrent Cesarean scar pregnancy: observations of a case and historical perspective. Ultrasound Obstet Gynecol 2017; 50: 658-660.
    1. Jurkovic D, Knez J, Appiah A, Farahani L, Mavrelos D, Ross JA. Surgical treatment of Cesarean scar ectopic pregnancy: efficacy and safety of ultrasound-guided suction curettage. Ultrasound Obstet Gynecol 2016; 47: 511-517.
    1. Uludag SZ, Kutuk MS, Ak M, Ozgun MT, Dolanbay M, Aygen EM, Sahin Y. Comparison of systemic and local methotrexate treatments in cesarean scar pregnancies: time to change conventional treatment and follow-up protocols. Eur J Obstet Gynecol Reprod Biol 2016; 206: 131-135.
    1. Washburn EE, Pocius K, Carusi D. Outcomes of nonsurgical versus surgical treatment of cesarean scar pregnancies in the first trimester. Arch Gynecol Obstet 2017; 296: 533-541.
    1. Grechukhina O, Deshmukh U, Fan L, Kohari K, Abdel-Razeq S, Bahtiyar MO, Sfakianaki AK. Cesarean Scar Pregnancy, Incidence, and Recurrence: Five-Year Experience at a Single Tertiary Care Referral Center. Obstet Gynecol 2018; 132: 1285-1295.
    1. Chen L, Xiao S, Zhu X, He S, Xue M. Analysis of the Reproductive Outcome of Patients with Cesarean Scar Pregnancy Treated by High-Intensity Focused Ultrasound and Uterine Artery Embolization: A Retrospective Cohort Study. J Minim Invasive Gynecol 2019; 26: 883-890.
    1. Stepniak A, Paszkowski T, Jargiello T, Czuczwar P. Effectiveness, complications and reproductive outcome of selective chemoembolization with methotrexate followed by suction curettage for caesarean scar pregnancy - A prospective observational study. Eur J Obstet Gynecol Reprod Biol 2019; 241: 56-59.
    1. Zhang C, Zhang Y, He J, Zhang L. Outcomes of subsequent pregnancies in patients following treatment of cesarean scar pregnancy with high intensity focused ultrasound followed by ultrasound-guided dilation and curettage. Int J Hyperthermia 2019; 36: 926-931.
    1. Orhan A, Kasapoglu I, Cetinkaya Demir B, Ozerkan K, Duzok N, Uncu G. Different treatment modalities and outcomes in cesarean scar pregnancy: a retrospective analysis of 31 cases in a university hospital. Ginekol Pol 2019; 90: 291-307.
    1. Wei LK, Yu LM, Mu RM, Xue FX. [Reproductive outcomes following women with previous cesarean scar pregnancy]. Zhonghua Yi Xue Za Zhi 2018; 98: 2194-2197.
    1. Zong L, Liu Y, Zhou Y, Luo S. Successful Treatment of a Recurrent Cesarean Scar Pregnancy by Transvaginal Cesarean Scar Pregnancy Lesion Resection: A Case Report. J Reprod Med 2016; 61: 595-597.
    1. Lu JY, Gu JP, Xu WJ, Lou WS, Shi WY, Wang T, Shao ZF. [Clinical application and prognostic analysis of interventional treatment for cesarean scar pregnancy]. Beijing Da Xue Xue Bao Yi Xue Ban 2016; 48: 1012-1018.
    1. Ndubizu C, McLaren RA, Jr., McCalla S, Irani M. Recurrent Cesarean Scar Ectopic Pregnancy Treated with Systemic Methotrexate. Case Rep Obstet Gynecol 2017; 2017: 9536869.
    1. Tantbirojn P, Crum CP, Parast MM. Pathophysiology of placenta creta: the role of decidua and extravillous trophoblast. Placenta 2008; 29: 639-645.
    1. Ahmed A, Dunk C, Ahmad S, Khaliq A. Regulation of placental vascular endothelial growth factor (VEGF) and placenta growth factor (PIGF) and soluble Flt-1 by oxygen--a review. Placenta 2000; 21 Suppl A: S16-24.
    1. Genbacev O, Zhou Y, Ludlow JW, Fisher SJ. Regulation of human placental development by oxygen tension. Science 1997; 277: 1669-1672.
    1. Muttukrishna S, Suri S, Groome N, Jauniaux E. Relationships between TGFbeta proteins and oxygen concentrations inside the first trimester human gestational sac. PLoS One 2008; 3: e2302.
    1. Tseng JJ, Chou MM, Hsieh YT, Wen MC, Ho ES, Hsu SL. Differential expression of vascular endothelial growth factor, placenta growth factor and their receptors in placentae from pregnancies complicated by placenta accreta. Placenta 2006; 27: 70-78.
    1. Qian ZD, Weng Y, Du YJ, Wang CF, Huang LL. Management of persistent caesarean scar pregnancy after curettage treatment failure. BMC Pregnancy Childbirth 2017; 17: 208.
    1. Monteagudo A, Carreno C, Timor-Tritsch IE. Saline infusion sonohysterography in nonpregnant women with previous cesarean delivery: the “niche” in the scar. J Ultrasound Med 2001; 20: 1105-1115.
    1. Antoine C, Pimentel RN, Reece EA, Oh C. Endometrium-free uterine closure technique and abnormal placental implantation in subsequent pregnancies. J Matern Fetal Neonatal Med 2019. DOI: 10.1080/14767058.2019.1670158.
    1. Morlando M, Buca D, Timor-Tritsch I, Giuseppe C, Palacios-Jaraquemada J, Monteagudo A, Khalil A, Cennamo C, LaManna V, Liberati M, D'Amico A, Nappi L, Colacurci N, D'Antonio F. Reproductive outcome after cesarean scar pregnancy: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2020; 99: 1278-1289.
    1. Kaelin Agten A, Monteagudo A, Timor-Tritsch IE, Thilaganathan B. Cesarean Scar Pregnancy Registry: an international research platform. Ultrasound Obstet Gynecol 2020; 55: 438-440.

Source: PubMed

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