Management Options in Early Pregnancy

Dr. Zeynep Şeyhanlı1
Prof. Dr. Ali Turhan Çağlar2

1Department of Perinatology, Ankara Etlik City Hospital, Ankara, Türkiye
2Department of Perinatology, Ankara Etlik City Hospital, Ankara, Türkiye

ABSTRACT

Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy that can cause serious maternal mortality and morbidity, such as severe hemorrhage, uterine rupture, loss of fertility, and hysterectomy. While cesar- ean scar pregnancy was previously thought to be a risk factor for placenta accreta spectrum (PAS), recent studies have shown that CSP is the precursor of PAS and exhibits a shared histology with it, suggesting that these two conditions are probably different stages of the same disease that follow each other. Many treat- ment options have been proposed in the management of CSP, but the optimal treatment management has not yet been determined due to its rarity. The management options in CSP can be categorized into three groups: expectant management, surgical management, and medical management. When selecting treatment options for managing CSP, it is essential to take into account various factors, including the patient’s age, the gestational age, the type of CSP, the residual myometrial thickness, the level of serum beta-human chorionic gonadotropin, the presence of fetal cardiac activity, the patient’s hemodynamics status, the patient’s fertility plan, and the experience of the treating team. Expectant management of CSP is not recommended because it may be associated with serious maternal morbidity and mortality. Sharp curettage and the use of systemic methotrexate alone are not recommended in the management of CSP. Nevertheless, patients who still prefer expectant treatment in CSP, are recommended to have a cesarean delivery between 34 0/7 and 35 6/7 weeks of pregnancy. Patients who have been treatment for CSP and still have the ability to conceive should receive comprehensive counseling regarding potential risks in future pregnancies and should be informed about ef- fective contraceptive methods.

Keywords: Cesarean scar pregnancy; Placenta accreta spectrum; Management options

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