Aya Michaels MD, Presenter: Nothing to Disclose

Erin Washburn MD, Abstract Co-Author: Nothing to Disclose

Katherine Pocius MD, Abstract Co-Author: Nothing to Disclose

Carol Beer Benson MD, Abstract Co-Author: Nothing to Disclose

Peter Michael Doubilet MD, PhD, Abstract Co-Author: Nothing to Disclose

Daniela Carusi MD, Abstract Co-Author: Nothing to Disclose

To determine the outcome of cesarean scar implantation pregnancies diagnosed during the first trimester.

We retrospectively identified all cesarean scar implantation pregnancies diagnosed by ultrasound prior to 14 weeks between 2000 and 2012 at our institution. We reviewed the patients' sonographic images and medical records, and recorded information about sonographic findings and pregnancy outcome.

37 cases met study entry criteria. Gestational age (GA) at diagnosis was 6.8 ± 1.6 weeks (mean ± SD). Anterior myometrial thickness overlying the gestational sac was 2.7 ± 2.2 mm. 11 patients had no embryonic cardiac activity at the time of diagnosis or thereafter, 6 of whom underwent ultrasound-guided D&C or were given systemic methotrexate. Of these 11, only 1 required hysterectomy, which occurred a month after initial diagnosis for persistent bleeding. Among the 26 patients with embryonic cardiac activity, 9 continued the pregnancy, 2 required emergent hysterectomy for dehiscence at the time of diagnosis (GA 10 and 11 weeks), and 15 underwent interruption of the pregnancy during the first trimester by one of several methods: intrasac KCl injection (8 cases); ultrasound-guided D&C (6 cases); laparascopic resection (1 case). None of the latter 15 interrupted cases subsequently required hysterectomy. Of the 9 uninterrupted pregnancies, 3 had miscarriages (GA 9, 9, and 20 weeks) and 6 had liveborn deliveries, of whom 4 had placenta accreta, 3 requiring hysterectomy. 

In a woman with a cesarean scar implantation pregnancy and embryonic cardiac activity, allowing the pregnancy to proceed has high risk of subsequent miscarriage (33%). Those pregnancies that continue to delivery of a liveborn infant are at substantial risk of placenta accreta (66%) requiring hysterectomy (50%).

Cesarean scar implantation pregnancies, if untreated, are at high risk for miscarriage and/or serious complications, including uterine dehiscence and placenta accreta requiring hysterectomy.

Michaels, A, Washburn, E, Pocius, K, Benson, C, Doubilet, P, Carusi, D, Outcome of Cesarean Scar Implantation Pregnancies Diagnosed Sonographically in the First Trimester.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13019034.html