Subsequent pregnancy outcome after conservative treatment of a previous cesarean scar pregnancy.
BACKGROUND
To assess pregnancy course and outcome after conservative treatment of a cesarean scar pregnancy.


METHODS
During an 8-year period, 15 cases of cesarean scar pregnancies were diagnosed at our institution. Seven of the 14 patients for whom we successfully preserved the uterus became pregnant within 3 years after termination of the scar pregnancy. The year of diagnosis, conservative method and gestational age for these five patients were recorded. Delivery method, time interval between the scar pregnancy and subsequent pregnancy, and maternal and neonatal outcome were evaluated.


RESULTS
Seven pregnancies (eight live and one dead baby) were noted. The mean interval between the ectopic pregnancy and subsequent pregnancy was 13.3 months (range 0-34 months). One patient, who became pregnant 3 months after the scar pregnancy was found, suffered uterine rupture at 38.3 weeks' gestational age. Two patients with placental accrete, and one of them who continued the existing intrauterine twin pregnancy after transvaginal sono-guided aspiration of the scar pregnancy received a cesarean hysterectomy at 32 weeks of gestation. The remaining four pregnancies were uneventful, followed by early cesarean sections at 36 weeks.


CONCLUSIONS
The results of this first series of seven subsequent pregnancies after conservative treatment of scar pregnancies are promising. An early cesarean section before over-extension of the uterus and spontaneous labor can help to prevent uterine rupture. Placenta accrete is another severe morbidity of these patients in addition to uterine rupture. Thus a cesarean hysterectomy may be the choice of treatment.
Seow
Kok-Min
KM
Department of Obstetrics and Gynecology, Shin-Kong Wu-Ho-Su Memorial Hospital, Taipei, Taiwan.
Hwang
Jiann-Loung
JL
Tsai
Yieh-Loong
YL
Huang
Lee-Wen
LW
Lin
Yu-Hung
YH
Hsieh
Bin-Chwen
BC
D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix / Q000150:complications* / Q000209:etiology; D005260:Female; D005313:Fetal Death; D005865:Gestational Age; D006801:Humans; D007044:Hysterectomy; D010921:Placenta Accreta / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000517:prevention & control; D011247:Pregnancy; D011256:Pregnancy Outcome; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D011272:Pregnancy, Multiple; D014427:Twins; D014463:Ultrasonography; D014597:Uterine Rupture / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000517:prevention & control