Managing Caesarean Scar Pregnancy in low Resource Settings: 2 Case Reports and a Description of Transrectal Ultrasound guided Surgical Approach (TRUGA).

Uche A. Menakaya, Tihomir Djordjic, Rhett Morton, Sarah Crook, Bruno Giorgio, Fernando Infante, George Condous

Abstract

Caesarean scar pregnancy (CSP) occurs when an embryo implants in a previous caesarean section scar. It has a reported incidence of 1 in 1800. Various surgical and medical techniques have been described in case reports for the management of CSP. These techniques are usually undertaken in tertiary level units with significant resource availability. In this paper, we present a new clinical perspective for the management of CSP in low resource settings and describe the steps involved in a transrectal ultrasound guided approach with dilatation of uterine cervix and subsequent evacuation of uterine contents (TRUGA with D&C). (Afr. J Reprod Health 2015; 19[3]: 27-31).

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References

Jurkovic D, Hillaby K, Worlfer B, Lawrence A, Salim

R, Elson CJ. First trimester diagnosis and management of pregnancies implanted into the lower uterine caesarean section scar. Ultrasound Obstet Gyneocl 2003; 21:220 – 7.

Larsen JV, Solomon MH. Pregnancy in a uterine scar

Sacculus - An unusual case of postabortal haemorrhage. A case report. S Afr. Med J 1978; 28:142 - 3.

Ash A, Smith A, Maxwell D. Caesarean scar pregnancy.

BJOG 2007; 114: 253 – 263.

Fylstra DL. Ectopic pregnancy within a caesarean scar:

A review. Obstet Gynecol Surv 2002;57:537–43.

Godin PA, Bassil S, Donnez J. An ectopic pregnancy

developing in a previous caesarean section scar. Fertil Steril 1997; 67: 398 – 400.

Seow KM, Cheng WC, Chuang J, Lee C, Tsai YL, #

Hwang JL. Methotrexate for Caesarean scar pregnancy after invitro fertilization and embryo transfer. A case report. J Reprod Med 2000;45:754 – 7.

Smith A, Maxwell d, Ash A. Sonographic diagnosis of

caesarean scar pregnancy at 16week. J Clin Ultrasound. 2007;35 (4):212 - 5.

Rotas MA, Haberman S, Levgur M. Caesarean scar

Ectopic pregnancies: aetiology, diagnosis and

management. Obstet Gynaecol 2006;107:1373–7.

Weimin W, Wenqing L. Effect of early pregnancy on a

previous lower segment caesarean section scar. Int J Gynaecol Obstet 2002; 77:201 – 7.

Seow KM, Huang LW. Lin YH, Yan-Sheng Lin M, Tsai

YL, Hwang JL. Caesarean scar pregnancy: issues in management. Ultrasound Obstet Gynaecol 2004; 23:247 - 53

Shih JC. Caesarean scar pregnancy: diagnosis with three

dimensional (3D) ultrasound and 3D power

Doppler. Ultrasound Obstet Gynaecol 2004;

:306 - 7.

Valley MT, Pierce JG, Daniel TB Kaunitz AM.

Caesarean scar pregnancy: imaging and treatment with conservative surgery. Obstet Gynaecol 1998; 91: 838 – 40.

Roberts H, Kohlenber C, Lanzarone v, Murray H.

Ectopic pregnancy in lower segment uterine scar. Aust NZJ Obstet Gynaecol 1998; 38: 114 -16.

Godin PA, Bassil S, Donnez J. An ectopic pregnancy

developing in a previous caesarean section scar. Fertil Steril 1997; 67:398 - 400.

Neiger R, Weldon K, Means N. Intramural pregnancy in

a caesarean section scar. A case report. J Reprod Med 1998;43: 999–1001.

Ayoubi JM, Fanchin R, Meddoun M et al. Conservative

treatment of complicated caesarean scar pregnancy. Acta Obstet Gynecol 2001;80:469 -70.

Lee CL, Wang CJ, Chao A et al. Laparoscopic

Management of an ectopic pregnancy in a previous Caesarean section scar. Hum Reprod 1999; 14:1234 – 6.

Bignardi T and Condous G. Transrectal ultrasound

guided surgical evacuation of caesarean scar pregnancy. Ultrasound Obstet Gynaecol 2010; 35: 481 – 48.

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