Overcash Rachael T, Khackician Zareh H
Department of Obstetrics and Gynecology, INOVA Fairfax Hospital, Falls Church, VA, USA.
J Reprod Med. 2012 Jan-Feb;57(1-2):61-4.
Cesarean section scar pregnancy is a rare ectopic pregnancy that is difficult to manage due to high risk of uterine rupture and maternal hemorrhage-a risk that increases with gestational age.
A 21-year-old, gravida 3 para 2 woman was diagnosed at 13.5 weeks' gestation by pelvic ultrasound and magnetic resonance imaging with a cesarean scar ectopic pregnancy and placenta increta. Surgical removal of the pregnancy via exploratory laparatomy with intraoperative use of vasopressin minimized initial blood loss. However, extraction of the placenta increta resulted in uncontrolled bleeding, requiring a supracervical hysterectomy.
This is the first case report, to our knowledge, of a late-first-trimester cesarean section scar ectopic pregnancy with placenta increta. Early identification of the ectopic pregnancy may allow for more conservative, nonsurgical management. However, with a more advanced gestational age and placenta increta, surgical management is most appropriate to minimize associated maternal risks. A transverse wedge resection of the implantation site, uterine artery embolization, uterine artery ligation, endovascular balloon catheters, or uterine artery tourniquet may help decrease bleeding during surgical extraction of the pregnancy and placenta increta, and also may prevent a hysterectomy.
剖宫产瘢痕妊娠是一种罕见的异位妊娠，由于子宫破裂和母体出血风险高，难以处理，且该风险随孕周增加而上升。
一名21岁、孕3产2的女性在孕13.5周时经盆腔超声和磁共振成像诊断为剖宫产瘢痕异位妊娠并胎盘植入。通过剖腹探查术手术切除妊娠物，术中使用血管加压素使初始失血量降至最低。然而，胎盘植入物的取出导致无法控制的出血，需要进行次全子宫切除术。
据我们所知，这是首例孕早期晚期剖宫产瘢痕异位妊娠合并胎盘植入的病例报告。早期识别异位妊娠可能允许采取更保守的非手术治疗。然而，随着孕周增加和胎盘植入，手术治疗最适合将相关母体风险降至最低。植入部位的横向楔形切除术、子宫动脉栓塞术、子宫动脉结扎术、血管内球囊导管或子宫动脉止血带可能有助于减少手术取出妊娠物和胎盘植入物时的出血，也可能避免子宫切除术。
