Solved on SIR Connect
By Jackson Bennet, MD, Patrick Moran, MD, Brian Strife, MD, and Sudhen B. Desai, MD, FSIR
Cesarean section scar ectopic pregnancy
Original post, lightly edited for flow. View full post:
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Brian Strife, MD:
One of our OBs is interested in uterine artery embolization as part of a treatment pathway for cesarean scar pregnancy. On my review, there is good bit of international experience and published studies/protocols out there, but a paucity of published U.S. experience. I’m curious if anyone has experience with this and/or an established pathway at their institution that employs embolization in certain cases.
In your own words, what is an accepted definition for cesarean section scar ectopic pregnancy? Brian Strife, MD: Cesarean scar pregnancy (CSP) is a type of ectopic pregnancy whereby the embryo implants in a previous cesarean scar. The position of the implantation along the scar track further subclassifies the CSP into different types with potentially different treatments offered for each type.
Please elaborate on the specific patient background and presentation in this case. The patient is in her mid-30s with a history of two prior deliveries by cesarean section. She unexpectedly became pregnant, and ultrasound demonstrated
Transvaginal US images obtained approximately 3-months post direct injection of methotrexate into the gestational sac showed a normal sized anteverted uterus. There was a fluid filled structure present at the anterior utero-cervical junction measuring 1.8 x 1.5 x 1.8 cm at the site of the cesarean scar pregnancy consistent with a residual gestational sac. No internal contents visualized. No vascularity apparent.
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