Non-developing pregnancy in the uterine scar after caesarean section: diagnostic difficulties
Background: The steady increase in the number of patients with a history of even one caesarean section leads to a rise in the frequency of such form of ectopic pregnancy, as pregnancy in the scar. The choice of the optimal organ-sparing treatment option for this category of patients depends on timely diagnosis. The formation of retrochorial hematoma that accompanies non-developing pregnancy in the scar in the early stages significantly complicates the diagnosis.Kurtser M.A., Breslav I.Yu., Kolotilova M.L., Barykina O.P., Skryabin N.V., Kurbatskaya O.N.
Case report: The paper describes a clinical case of a reproductive-aged patient, in whom a long episode of menometrorrhagia ended with the formation of a round mass up to 8 cm in diameter in the area of the scar after cesarean section at the uterine isthmus. Erroneously diagnosed incomplete abortion during uterine pregnancy and uterine fibroids served as a reason for uterine curettage complicated by massive blood loss. The final diagnosis was established after pathological mass excision and metroplasty.
Conclusion: A pathological uterine mass localized in the scar area after cesarean section, which is suddenly detected during abnormal uterine bleeding, requires the exclusion of pregnancy in this area. Correct diagnosis of non-developing pregnancy in the scar is the key to successful organ-sparing surgery.
Authors’ contributions: Kurtser M.A. – the main ideologist of organ-sparing surgery for an incompetent uterine scar, editing the text; Breslav I.Yu. – concept and design of the investigation, writing the text, design of illustrative material; Kolotilova M.L. – editing the text; Barykina O.P. – morphopathological examination of a sample, drawing up a medical report; Skryabin N.V. – morphopathological examination of a sample, compilation of photographic materials; Kurbatskaya O.N. – literature study and analysis, editing the text.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: The investigation has not been sponsored.
Patient Consent for Publication: The female patient has signed an informed consent form to the publication of her data and the results of her tests.
For citation: Kurtser M.A., Breslav I.Yu., Kolotilova M.L.,
Barykina O.P., Skryabin N.V., Kurbatskaya O.N. Non-developing pregnancy in the uterine scar after caesarean section: diagnostic difficulties.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2023; (2): 160-164 (in Russian)
https://dx.doi.org/10.18565/aig.2022.214
Keywords
pregnancy in the scar
incompetent uterine scar
niche in the scar area
non-developing pregnancy
References
- Министерство здравоохранения Российской Федерации. Клинические рекомендации. Внематочная (эктопическая) беременность. М.; 2021. [Ministry of Health of Russian Federation. Clinical guidelines. Ectopic (ectopic) pregnancy, 2021. (in Russian)].
- Барановская Е.И. Эктопия плодного яйца и гетеротопическая беременность. Медицинские новости. 2018; 4: 9-11. [Baranouskaya А.I. Ectopia of gestational sac and heterotopic pregnancy. Meditsinskie novosti/Medical news. 2018; 4: 9-11. (in Russian)].
- Щепелев М.Е., Дерипаско Т.В., Сидорова А.А., Драндрова Е.Г., Москвичев Е.В., Леонтьева Т.Ю., Афанасьев Д.А. Клинический случай неразвивающейся беременности в рубце на матке после кесарева сечения. Acta Medica Eurasica. 2021; 3: 26-34. https://dx.doi.org/10.47026/2413-4864-2021-3-26-34. [M.E. Shchepelev, T.V. Deripasko, A.A. Sidorova,E.G. Drandrova, E.V. Moskvichev, T.Yu. Clinical case of non-developing pregnancy in the uterine scar after caesarean section. Acta Medica Eurasica. 2021; 3: 26-34. (in Russian)]. https://dx.doi.org/10.47026/2413-4864-2021-3-26-34.
- Буянова С.Н., Щукина Н.А., Чечнева М.А., Пучкова Н.В., Земскова Н.Ю., Торобаева М.Т. Беременность в рубце после кесарева сечения: возможности хирургической коррекции. Российский вестник акушера-гинеколога. 2020; 20(6): 65-70. https://dx.doi.org/10.17116/rosakush20202006165. [Buyanova S.N., Shchukina N.A., Chechneva M.A., Puchkova N.V., Zemskova N.Yu., Torobaeva M.T. Pregnancy in the scar after caesarean section: the possibility of surgical correction. Russian Bulletin of the Obstetrician-Gynecologist. 2020; 20(6): 65-70. (in Russian)].https://dx.doi.org/10.17116/rosakush20202006165.
- Захаров И.С., Елгина С.И., Мозес В.Г., Рудаева Е.В., Пачгин И.В., Рыбников С.В. Эктопическая беременность в рубце после кесарева сечения. Мать и дитя в Кузбассе. 2020; 4: 88-91. https://dx.doi.org/10.24411/2686-7338-2020-10055. [Zakharov I.S., Elgina S.I., Mozes V.G., Rudaeva E.V., Pachgin I.V., Rybnikov S.V. Ectopic pregnancy in the scar after caesarean section. Mother and Child in Kuzbass. 2020; 4: 88-91. (in Russian)].https://dx.doi.org/10.24411/2686-7338-2020-10055.
- Timor-Tritsch I.E., Monteagudo A. Unforeseen consequences of the increasing rate of cesarean deliveres: early placenta accrete and cesarean scar pregnancy. A review. Am. J. Obstet. Gynecol. 2012; 207(1): 14-29. https://dx.doi.org/10.1016/j.ajog.2012.03.007.
Received 08.09.2022
Accepted 08.11.2022
About the Authors
Mark A. Kurtser, MD, PhD, Professor, Member of the Russian Academy of Sciences, Head of Department of Obstetrics and Gynecology, Pediatric Faculty, Pirogov Russian National Research Medical University, Ministry of Health of Russia, +7(495)719-78-96, m.kurtser@mcclinics.ru, https://orcid.org/0000-0003-0175-1968,1 Ostrovityanov str., Moscow, 117997, Russia.
Irina Yu. Breslav, MD, PhD, Head of the Department of Pathology of Pregnancy, Hospital MD GROUP, +7(495)331-44-85, irina_breslav@mail.ru,
https://orcid.org/0000-0002-0245-4968, 24/1 Sevastopol Ave., Moscow, 111720, Russia.
Marina L. Kolotilova, MD, PhD, Professor at Human Pathology Department, Institute of Biodesign and Modeling of Complex Systems, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), +7(903)201-75-31, Kolotilovaml@hotmail.com,
https://orcid.org/0000-0001-7270-8671, 8-2 Trubetskaya str., Moscow, 119991, Russia.
Olga P. Barykina, Head of the Department of Pathology, Pathologist, Hospital MD GROUP, +7(495)332-20-22, medslovar@mail.ru, https://orcid.org/0000-0003-4943-0741, 24/1 Sevastopol Ave., Moscow, 111720, Russia.
Nikolay V. Scriabin, Pathologist at the Department of Pathology, Hospital MD GROUP, +7(495)332-20-22, hranitelkr@mail.ru,
https://orcid.org/0000-0001-8247-7563, 24/1 Sevastopol Ave., Moscow, 111720, Russia.
Olga N. Kurbatskaya, MD, Head of the Department of Pathology of Pregnancy, Clinical hospital "Lapino", +7(495)526-60-60, kuron682@gmail.com,
111 1st Uspenskoe highway, Moscow region, Odintsovo district, 143081, Russia.
Corresponding author: Irina Yu. Breslav, irina_breslav@mail.ru
Similar Articles
