Kutlesic Ranko, Kutlesic Marija, Vukomanovic Predrag, Stefanovic Milan, Mostic-Stanisic Danka
Clinic of Gynaecology and Obstetrics, University Clinical Centre Nis, 18000 Nis, Serbia.
Faculty of Medicine, University of Nis, 18000 Nis, Serbia.
Medicina (Kaunas). 2020 Sep 24;56(10):496. doi: 10.3390/medicina56100496.
Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy, defined as the implantation of the gestational sac at the uterine incision scar of the previous cesarean section. This condition is associated with severe maternal and fetal/neonatal complications, including severe bleeding, rupture of the uterus, fetal demise, or preterm delivery. In view of these, early diagnosis allows the option of termination of pregnancy. In this case report, we present a patient with a cesarean scar pregnancy who was diagnosed at the sixth week of gestation but declined early termination of the pregnancy and was managed to the 38th week. Placenta previa was confirmed in the second trimester. A planned cesarean section was performed that resulted in the birth of a live full-term neonate. Intraoperatively, placenta percreta was diagnosed, and due to uncontrollable bleeding, a hysterectomy was performed. The postoperative course was uneventful. In cases where an early diagnosis of CSP is made, women should be counseled that this will almost certainly evolve to placenta previa, and the associated risks should be explained. Close follow-up of CSP is mandatory if expectant management is selected. Further studies are needed for definitive conclusions and to determine the risks of expectant management.
剖宫产瘢痕妊娠（CSP）是一种罕见的异位妊娠形式，定义为妊娠囊着床于既往剖宫产子宫切口瘢痕处。这种情况与严重的母婴及胎儿/新生儿并发症相关，包括严重出血、子宫破裂、胎儿死亡或早产。鉴于此，早期诊断可选择终止妊娠。在本病例报告中，我们介绍了一名剖宫产瘢痕妊娠患者，其在妊娠第6周被诊断出，但拒绝早期终止妊娠，并一直维持到第38周。孕中期确诊为前置胎盘。计划行剖宫产，结果娩出一名足月活产新生儿。术中诊断为穿透性胎盘植入，因出血无法控制，行子宫切除术。术后过程顺利。在早期诊断出CSP的病例中，应告知女性这种情况几乎肯定会发展为前置胎盘，并解释相关风险。如果选择期待治疗，对CSP进行密切随访是必要的。需要进一步研究以得出明确结论并确定期待治疗的风险。
