Complication of cesarean section: pregnancy on the cicatrix of a previous cesarean section.
OBJECTIVE
To probe into the clinical manifestation, diagnosis, as well as treatment of pregnancy on the cicatrix of a previous cesarean section at the uterine isthmus in the first trimester.


METHODS
Analysis of 14 patients with pregnancy on the cicatrix of a previous cesarean section at the uterine isthmus in the first trimester was made after conservative treatment by drugs from January 1996 to December 1999.


RESULTS
The 14 patients with a pregnancy on the cicatrix of a previous cesarean section at the uterine isthmus in the first trimester were painless, had slight vaginal bleeding, and concurrently had increased serum beta-subunit human chorionic gonadotropin (beta-HCG). Doppler ultrasonic examination revealed an obvious enlargement of the previous cesarean section cicatrix in the uterine isthmus, and found a gestational sac or mixed mass attached to the cicatrice, with a very thin myometrium between the gestational sac and bladder walls. Among the 14 patients, 12 patients had crystalline trichosanthes injected into the cervix, mifepristone taken orally, or methotrexate in the form of intramuscular injection. Following this procedure, their serum beta-HCG dropped to normal. The other 2 patients had a total hysterectomy.


CONCLUSIONS
Pregnancy on the cicatrix of a previous cesarean section at the uterine isthmus in the first trimester is a complication of cesarean section. Early diagnosis and effective conservative treatment by drugs are instrumental in decreasing the potential occurrence of uterine rupture, which is also conducive to preserving the patient's future fertility.
Wang
Weimin
W
Department of Gynecology and Obstetrics, Zhabei District Central Hospital, Shanghai 200070, China. wangwmz@online.sh.cn
Long
Wenqing
W
Yu
Qunhuan
Q
D000328:Adult; D002585:Cesarean Section; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood / Q000187:drug effects; D002921:Cicatrix / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D015735:Mifepristone / Q000627:therapeutic use; D009215:Myometrium / Q000000981:diagnostic imaging; D008517:Phytotherapy; D028321:Plant Preparations / Q000627:therapeutic use; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011247:Pregnancy; D029778:Trichosanthes; D014463:Ultrasonography; D014597:Uterine Rupture / Q000209:etiology / Q000517:prevention & control; D014599:Uterus / Q000000981:diagnostic imaging
D018997:Chorionic Gonadotropin, beta Subunit, Human; D028321:Plant Preparations; D015735:Mifepristone; D008727:Methotrexate