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Human Reproduction Update Advance Access published online on September 16, 2004
Human Reproduction Update, doi:10.1093/humupd/dmh042
Copyright © 2004 by the European Society of Human Reproduction and Embryology.
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Received July 24, 2004
Revised August 9, 2004
Accepted August 11, 2004

Review

Ectopic pregnancies in a Caesarean scar: review of the medical approach to an iatrogenic complication

R. Maymon 1*, R. Halperin 1, S. Mendlovic 2, D. Schneider 1, and A. Herman 1

1 Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv, Israel
2 Institute of Pathology, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

* To whom correspondence should be addressed. E-mail: intposgr{at}post.tau.ac.il.


  Abstract

Implantation of a pregnancy within a Caesarean fibrous tissue scar is considered to be the rarest form of ectopic pregnancy and a life-threatening condition. We conducted a computer search of the English literature of all studies since 2002 to gather updated data on the outcome of such pregnancies. Sixty-six new cases were reported since 2002, possibly reflecting the increasing number of Caesareans currently being performed as well as the more widespread use of the transvaginal scan allowing their earlier detection. Analysis of these women's obstetric history revealed that those at risk for pregnancy in a Caesarean scar appear to have a history of dilatation and curettage, placental pathology, ectopic pregnancy, and IVF. Twenty-one out of 39 for which this information was available (54%) had undergone multiple (≥2) Caesareans and 13 had previous dilatation and curettage, which might also be an associated factor. We review and discuss the features of contemporary work-ups, including a high index of awareness, a detailed history and a skilful ultrasound examination for an early and accurate diagnosis. Healthcare professionals should be familiar with the possibility of untoward sequelae and how a modern work-up can help in guiding conservative options, thus reducing morbidity and preserving fertility.

Keywords: pregnancy in scar; sonography; treatment.
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