Cesarean Scar Pregnancies
Cesarean scar pregnancies are one of the long-term complications of cesarean sections and their frequency is 0.15% among all pregnancies. If this condition is not recognized and treated early, it can lead to life-threatening problems. Cesarean scar pregnancy can lead to life-threatening bleeding that cannot be controlled as the pregnancy grows, uterine ruptures and removal of the uterus and pregnancy loss. Ultrasonography (USG) is an important diagnostic tool in the first trimester of pregnancy in the diagnosis of the disease. Gestational sac (GS) is observed between the uterine muscle layer and the bladder. The patient’s complaints on admission may be abdominal pain and/or vaginal bleeding or may not present with any findings, and they are noticed during normal follow-ups. It is important to make the differential diagnosis of scar pregnancy from cervical, cervicoistmic pregnancies and miscarriages.
Diagnosis is made with the following criteria in transvaginal USG.
Empty uterine cavity, endometrium should be seen clearly,
empty cervical canal,
On the USG image of the uterus, the gestational sac located in the cesarean section between the lower segment and the bladder on the anterior wall of the uterus.
Although there are various methods such as curettage hysteroscopy, systemic drug applications, balloon application, the safest and most frequently applied method is drug application directly into the gestational sac. After the application, the β-hCG levels in the patient should be followed closely and it should be shown that the problem is eliminated without any problems. In some cases, a one-time application may not be sufficient for treatment, and additional interventions such as curettage hysteroscopy may be required. It should be kept in mind that there may be a very serious risk of bleeding during these additional interventions, and precautions should be taken accordingly.
In conclusion, cesarean scar pregnancy is a life-threatening clinical picture. However, it is a situation that can be handled smoothly with timely diagnosis and appropriate interventions after diagnosis.