title: Placenta Increta Complicating Persistent Cesarean Scar Ectopic Pregnancy following Failed Excision with Subsequent Preterm Cesarean Hysterectomy.
abstract: Introduction. Cesarean scar pregnancies (CSPs) are one of the rarest forms of ectopic pregnancy. Given their rarity, there is lack of consensus regarding the management and natural course of CSPs. Case. A 37-year-old G10 P3063 female with a history of two prior cesarean deliveries was diagnosed with her second CSP at 6 weeks and 5 days in her tenth pregnancy. The patient underwent vertical hysterotomy, excision of a gestational sac implanted in the cesarean sac, and bilateral salpingectomy via a laparotomy incision. The histopathology report confirmed immature chorionic villi. The patient returned 10 weeks later and was found to be still pregnant. Obstetric ultrasound confirmed a viable fetus of 19 weeks and 4 days of gestational age with a thin endometrium and an anteroposterior and right lateral placenta with multiple placental lakes. The patient ruptured her membranes at 31 weeks of gestation and pelvic MRI revealed an anterior placenta invading the myometrium and extending to the external serosal surface consistent with placenta increta. Following obstetric interventions, a live female infant was delivered by cesarean hysterectomy (because of placenta increta) at 32 weeks of gestation. Conclusion. Development of standardized guidelines for management of CSPs, as well as heightened vigilance for possible complications, is required for proper care and avoidance of potential morbidity and mortality.
authors.affiliation: Department of Obstetrics & Gynecology, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA.
authors.forename: M F
authors.identifier: 0000-0002-7306-203X
authors.initials: MF
authors.lastname: Malik
authors.affiliation: Department of Obstetrics & Gynecology, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA.
authors.forename: L R
authors.identifier: 0000-0003-1276-4844
authors.initials: LR
authors.lastname: Hoyos
authors.affiliation: Department of Obstetrics & Gynecology, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA.
authors.forename: J
authors.identifier: 0000-0002-4874-344X
authors.initials: J
authors.lastname: Rodriguez-Kovacs
authors.affiliation: Department of Obstetrics & Gynecology, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA.
authors.forename: J
authors.identifier: 0000-0002-6584-0751
authors.initials: J
authors.lastname: Gillum
authors.affiliation: Department of Radiology, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA.
authors.forename: S C
authors.identifier: 0000-0003-4424-5707
authors.initials: SC
authors.lastname: Johnson