Intrauterine ectopic pregnancy — ultrasound typing and treatment
, 1, 3
Abstract
Objectives: To analyze the correlation between ultrasound typing and treatment modality of patients with an intrauterine
ectopic pregnancy (cervical and cesarean scar).
Material and methods: We retrospectively enrolled 65 patients diagnosed with cesarean scar pregnancy (CSP) or cervical
pregnancy (CP) between February 2014 and May 2018. The cases were divided into two types according to the ultrasound
presentation with a gestational sac (GS, type I) or a heterogeneous mass (HM, type II). Type I was further divided into type
Ia (< 8 weeks) and type Ib (≥ 8 weeks); type II was defined as type IIa (with poor or no vascularity) and type IIb (with rich
vascularity). Three treatment methods were applied in each group.
Results: Of included cases, there were 53 CSP and 12 CP. There was no significant difference between Type I and Type
II groups in any variable. The beta human chorionic gonadotropin (β-hCG) level and gestational age of type IIb were
significantly higher compared to type IIa (p < 0.05). There was a positive correlation between ultrasound categories and
treatment methods (rs = 0.723, p = 0.000). Analysis of CSP cases of initial treatment failure indicated success rate of initial
dilation and curettage (D&C) was dependent upon ultrasonic types, mean sac diameter, gestational age, hCG level, and
number of cesarean sections.
Conclusions: The features of ultrasound imaging might provide an additional reference for the selection of clinical treatment
methods.
Keywords: cesarean scar pregnancycervical pregnancyultrasonography typingtreatment
References
- Chukus A, Tirada N, Restrepo R, et al. Uncommon Implantation Sites of Ectopic Pregnancy: Thinking beyond the Complex Adnexal Mass. Radiographics. 2015; 35(3): 946–959.
- Jachymski T, Moczulska H, Guzowski G, et al. Conservative treatment of abnormally located intrauterine pregnancies (cervical and cesarean scar pregnancies): a multicenter analysis (Polish series). J Matern Fetal Neonatal Med. 2018; 33(6): 993–998.
- Osborn DA, Williams TR, Craig BM. Cesarean scar pregnancy: sonographic and magnetic resonance imaging findings, complications, and treatment. J Ultrasound Med. 2012; 31(9): 1449–1456.
- Shavell VI, Abdallah ME, Zakaria MA, et al. Misdiagnosis of cervical ectopic pregnancy. Arch Gynecol Obstet. 2012; 285(2): 423–426.
- Raskin MM. Diagnosis of cervical pregnancy by ultrasound: a case report. Am J Obstet Gynecol. 1978; 130(2): 234–235.
- Tsai SW, Huang KH, Ou YC, et al. Low-lying-implantation ectopic pregnancy: a cluster of cesarean scar, cervico-isthmus, and cervical ectopic pregnancies in the first trimester. Taiwan J Obstet Gynecol. 2013; 52(4): 505–511.
- Ghaneie A, Grajo JR, Derr C, et al. Unusual ectopic pregnancies: sonographic findings and implications for management. J Ultrasound Med. 2015; 34(6): 951–962.
- Ravi Selvaraj L, Rose N, Ramachandran M. Pitfalls in Ultrasound Diagnosis of Cesarean Scar Pregnancy. J Obstet Gynaecol India. 2018; 68(3): 164–172.
- Liu D, Yang M, Wu Q. Application of ultrasonography in the diagnosis and treatment of cesarean scar pregnancy. Clin Chim Acta. 2018; 486: 291–297.
- Osborn DA, Williams TR, Craig BM. Cesarean scar pregnancy: sonographic and magnetic resonance imaging findings, complications, and treatment. J Ultrasound Med. 2012; 31(9): 1449–1456.
- Takahashi H, Usui R, Suzuki H, et al. Uterine-fundal hypoechoic mass: a possible ultrasound sign for cesarean scar pregnancy. Clin Exp Obstet Gynecol. 2017; 44(1): 88–92.
- Samal SK, Rathod S. Cervical ectopic pregnancy. J Nat Sci Biol Med. 2015; 6(1): 257–260.
- Api O, Unal O, Api M, et al. Ultrasonographic appearance of cervical pregnancy following successful treatment with methotrexate. Ultrasound Obstet Gynecol. 2006; 28(6): 845–847.
- OuYang Z, Yin Q, Xu Y, et al. Heterotopic cesarean scar pregnancy: diagnosis, treatment, and prognosis. J Ultrasound Med. 2014; 33(9): 1533–1537.
- Sun QL, Wu XH, Luo Li, et al. Characteristics of women with mixed mass formation after evacuation following uterine artery chemoembolization for cesarean scar pregnancy. Arch Gynecol Obstet. 2018; 297(4): 1059–1066.
- Birch Petersen K, Hoffmann E, Rifbjerg Larsen C, et al. Cesarean scar pregnancy: a systematic review of treatment studies. Fertil Steril. 2016; 105(4): 958–967.
- Gao L, Huang Z, Gao J, et al. Uterine artery embolization followed by dilation and curettage within 24 hours compared with systemic methotrexate for cesarean scar pregnancy. Int J Gynaecol Obstet. 2014; 127(2): 147–151.
- Le A, Li M, Xu Y, et al. Different Surgical Approaches to 313 Cesarean Scar Pregnancies. J Minim Invasive Gynecol. 2019; 26(1): 148–152.
- Maheux-Lacroix S, Li F, Bujold E, et al. Cesarean Scar Pregnancies: A Systematic Review of Treatment Options. J Minim Invasive Gynecol. 2017; 24(6): 915–925.
- Monteagudo A, Romero JA, Timor-Tritsch IE. Pregnancy in an Abnormal Location. Clin Obstet Gynecol. 2017; 60(3): 586–595.
- Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol. 2006; 107(6): 1373–1381.
- Moschos E, Wells CE, Twickler DM. Biometric sonographic findings of abnormally adherent trophoblastic implantations on cesarean delivery scars. J Ultrasound Med. 2014; 33(3): 475–481.
- Zhang H, Huang J, Wu X, et al. Clinical classification and treatment of cesarean scar pregnancy. J Obstet Gynaecol Res. 2017; 43(4): 653–661.
- Wu XQ, Zhang HW, Fang XL, et al. Factors associated with successful transabdominal sonography-guided dilation and curettage for early cesarean scar pregnancy. Int J Gynaecol Obstet. 2015; 131(3): 281–284.
