Objective: This study aimed to identify the best management options in decision making in cases of cervicoisthmic and cesarean scar pregnancies and rare forms of ectopic pregnancies with high rates of pregnancy-related morbidity in the first trimester, more commonly associated with assisted reproductive medicine.
Materials and Methods: We performed a literature review of the description of a case report of a cervicoisthmic pregnancy near a cesarean scar in a premature ovarian failure woman. She obtained pregnancy after ovum donation, hormonal therapy, and in vitro fertilization. The researchers focused on the MEDLINE/PubMed database articles on ectopic pregnancies, particularly on cesarean scar pregnancies, cervical pregnancies, and ectopic pregnancies after in vitro fertilization in English-language journals published from January 1996 to December 2011.
Results: The conservative or nonconservative options for medical or surgical treatments are disposables. Moreover, in literature, no consensus was found about the best treatment method.
Conclusions: Obstetricians should pay great attention to a possible cesarean scar pregnancy in patients with risk factors in their medical history. Until now, the rarity of these findings does not allow the definition of a commonly accepted management, so the best personalized approach may be guided by early recognition, close surveillance, and appropriate counseling. Further investigations are necessary to recognize high-risk factors for all ectopic pregnancies and those unique to cesarean scar ectopic pregnancies.
Cervicoisthmic pregnancies, especially in a previous cesarean scar, are rare ectopic pregnancies, potentially fatal, which have still unclear approach, treatment, and decision-making process.
1Department of Woman and Child Health – University of Padua, Padova; and 2Department of Obstetrics, Gynaecological and Neonatology Sciences – University of Parma, Parma, Italy
Reprint requests to: Salvatore Gizzo, MD, Dipartimento Salute della Donna e del Bambino, U.O.C. di Ginecologia e Ostetricia, Via Giustiniani 3, 35128 Padova, Italy. E-mail: email@example.com
The authors have declared they have no conflicts of interest.
Dr Saccardi monitored the ultrasound; Drs De Marchi and O. Anis followed up the patient during recovery, taking care of the patient before, during, and after the medical and surgical treatment; Drs Patrelli, Bertocco, and Noventa reviewed all the English literature on cesarean scar pregnancy; Drs Gizzo and Di Gangi wrote the article; Drs D’Antona and Nardelli supervised and approved the final version of the article.