Abstract
Aim:
The purpose of this review is to systematically review all the reported cases and case series of caesarean scar pregnancy (CSP) managed expectantly without any intervention in order to understand the outcomes of pregnancy which will guide clinicians and patients in making treatment choices.
Methods:
An electronic search on PubMed, EMBASE and Cochrane databases and a manual search from references of the articles were performed. Studies were selected based on inclusion and exclusion criteria. Data were extracted for various outcomes of pregnancy and the quality of the reports was assessed using a modified Delphi technique.
Results:
A total of 56 cases of CSP from 11 reports were included in the review, including 44 cases with foetal cardiac activity. Live births were achieved in 73% of cases with a quarter of them born before 34 weeks. Hysterectomy rates were 70%. In 12/44 (27%) of cases pregnancies were lost due to complications before 24 weeks. Most (67%) of the CSPs with no foetal cardiac activities resolved on expectant management and the remaining required intervention for bleeding.
Conclusions:
Caution should be exercised when choosing expectant management in cases of viable CSPs, and if chosen, the patient should be counselled adequately for possible outcomes including loss of pregnancy and hysterectomy. Expectant management is acceptable in CSPs with no foetal cardiac activity. There is a need for prospective research on this topic with adequate reporting on possible prognostic markers, as well as a need to improve on the techniques to prevent loss of fertility during delivery.
Author’s statement
Conflict of interest: Authors state no conflict of interest.
Material and methods: Informed consent: Informed consent has been obtained from all individuals included in this study.
Ethical approval: The research related to human subject use has complied with all the relevant national regulations, and institutional policies, and is in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional review board or equivalent committee.
References
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©2018 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Editorial
- Maternal medicine: an evolving discipline
- Corner of Academy
- Pregnancy after malignant disease – challenges and possibilities
- Review articles
- Animatio: a history of ideas on the beginning of personhood
- Expectant management of caesarean scar ectopic pregnancy: a systematic review
- Highlight articles
- Maternal outcomes in first and second trimester termination of pregnancy: which are the risk factors?
- A preliminary study of uterine scar tissue following cesarean section
- Catastrophic antiphospholipid syndrome (Ronald Asherson syndrome) and obstetric pathology
- Comparison of healthcare utilization and outcomes by gestational diabetes diagnostic criteria
- Adverse pregnancy outcomes and inherited thrombophilia
- Effect of female genital cutting performed by health care professionals on labor complications in Egyptian women: a prospective cohort study
- Letters to the Editor
- Effect of female genital cutting performed by health care professionals on labor complications in Egyptian women: methodological concerns
- Reply to: Effect of female genital cutting performed by health care professionals on labor complications in Egyptian women: methodological concerns
- Short communication
- Maternal plasma LPCAT 1 mRNA correlates with lamellar body count
- Original articles
- Experimental neonatal hypoxia ischemia causes long lasting changes of oxidative stress parameters in the hippocampus and the spleen
- Altered thymocyte and T cell development in neonatal mice with hyperoxia-induced lung injury
Artikel in diesem Heft
- Frontmatter
- Editorial
- Maternal medicine: an evolving discipline
- Corner of Academy
- Pregnancy after malignant disease – challenges and possibilities
- Review articles
- Animatio: a history of ideas on the beginning of personhood
- Expectant management of caesarean scar ectopic pregnancy: a systematic review
- Highlight articles
- Maternal outcomes in first and second trimester termination of pregnancy: which are the risk factors?
- A preliminary study of uterine scar tissue following cesarean section
- Catastrophic antiphospholipid syndrome (Ronald Asherson syndrome) and obstetric pathology
- Comparison of healthcare utilization and outcomes by gestational diabetes diagnostic criteria
- Adverse pregnancy outcomes and inherited thrombophilia
- Effect of female genital cutting performed by health care professionals on labor complications in Egyptian women: a prospective cohort study
- Letters to the Editor
- Effect of female genital cutting performed by health care professionals on labor complications in Egyptian women: methodological concerns
- Reply to: Effect of female genital cutting performed by health care professionals on labor complications in Egyptian women: methodological concerns
- Short communication
- Maternal plasma LPCAT 1 mRNA correlates with lamellar body count
- Original articles
- Experimental neonatal hypoxia ischemia causes long lasting changes of oxidative stress parameters in the hippocampus and the spleen
- Altered thymocyte and T cell development in neonatal mice with hyperoxia-induced lung injury