DOI: 10.32364/2618-8430-2025-8-4-1
Yu.E. Dobrokhotova1, V.A. Shaidorova2, I.Yu. Il'ina1, E.S. Platovа2, O.I. Kauseva2, S.A. Khlynova1, E.A. Markova1, M.R. Ramazanov1, O.A. Slyusareva3, V.I. Dimitrova3, N.A. Shevchenko4
1Pirogov Russian National Research Medical University, Moscow, Russian Federation
2N.I. Pirogov City Clinical Hospital No. 1, Moscow, Russian Federation
3F.I. Inozemtsev City Clinical Hospital, Moscow, Russian Federation
4City Clinical Hospital No. 52, Moscow, Russian Federation
Background: increased incidence of cesarean section is combined with more long-term complications associated with the surgical intervention. Ectopic pregnancy in the uterine scar is the most rare, but rather severe complication. Delayed or wrong diagnosis may cause several complications such as massive bleeding, chorionic penetration through the serous layer of the uterus and bladder that, in general, result in hysterectomy, and, in turn, worse quality of life in women of reproductive age. It is clear that timely correct diagnosis is the most important step to choose a therapeutic approach.
Aim: to determine ultrasound diagnostic criteria for pregnancy in the uterine scar to sel ect the best possible therapeutic approach.
Materials and Methods: a retrospective analysis of medical records was conducted in 25 women with non-developing pregnancy in the uterine scar. The patients were enrolled according to the developed inclusion criteria such as age fr om 24 to 48 years, absence of comorbidities (coagulation disorders, diabetes mellitus with vascular complications, pelvic neoplasms), and absence of inflammation in the lower genital tract.
Results: several correlations indicating an impact of mean sac diameter (MSD) of the gestational sac and residual myometrium thickness (RMT) on extent of blood loss and, in turn, on management of patients with pregnancy in the uterine scar. Thus, a surgical intervention (laparotomy, metroplasty) may be considered in patients with 1 mm < RMT <3 mm, MSD ≥23 mm and impossible vacuum aspiration of the uterine contents under laparoscopic control followed by metroplasty, as well as with chorionic penetration through the serous layer of the uterus.
Conclusion: to select the best possible treatment method, RMT and MSD (pelvic ultrasound data) must be used. Depending on these data, a therapeutic approach may be developed and the question of necessary vacuum aspiration of the uterine contents with or without hysteroscopy under ultrasound control (if applicable, combined with resection of the remaining chorial tissue under potential laparoscopic control and/or metroplasty associated with uterine artery embolization (UAE) or temporary occlusion of the uterine arteries during laparoscopy), may be settled. Actually, approved diagnostic criteria for "ectopic pregnancy in the uterine scar" are not available. That's exactly why the issue requires further investigation.
Keywords: ectopic pregnancy in the uterine scar, pregnancy in the uterine scar, non-developing pregnancy, cesarean section, diagnosis of ectopic pregnancy, postoperative niche.
For citation: Dobrokhotova Yu.E., Shaidorova V.A., Il'ina I.Yu., Platovа E.S., Kauseva O.I., Khlynova S.A., Markova E.A., Ramazanov M.R., Slyusareva O.A., Dimitrova V.I., Shevchenko N.A. Diagnostic capabilities in patients with non-developing ectopic pregnancy in the uterine scar. Russian Journal of Woman and Child Health. 2025;8(4):286–293 (in Russ.). DOI: 10.32364/2618-8430-2025-8-4-1
ABOUT THE AUTHORS:
Yulia E. Dobrokhotova — Dr. Sc. (Med.), Professor, Head of the Department of Obstetrics and Gynecology, Institute of Surgery, Pirogov Russian National Research Medical University; 1, Ostrovityanov str., Moscow, 117513, Russian Federation; ORCID iD 0000-0002-7830-2290
Vera A. Shaidorova — Obstetrician-Gynecologist, N.I. Pirogov City Clinical Hospital No. 1; 8, Leninskyi av., Moscow, 119049, Russian Federation.
Irina Yu. Il'ina — Dr. Sc. (Med.), Professor of the Department of Obstetrics and Gynecology, Institute of Surgery, Pirogov Russian National Research Medical University; 1, Ostrovityanov str., Moscow, 117513, Russian Federation; ORCID iD 0000-0001-8155-8775
Elena S. Platova — C. Sc. (Med.), Obstetrician-Gynecologist, Head of the Gynecological Department; N.I. Pirogov City Clinical Hospital No. 1; 8, Leninskyi av., Moscow, 119049, Russian Federation; ORCID iD 0009-0009-6999-4553
Olga I. Kauseva — C. Sc. (Med.), Ultrasound Specialist, N.I. Pirogov City Clinical Hospital No. 1; 8, Leninskyi av., Moscow, 119049, Russian Federation; ORCID iD 0000-0002-7117-7642
Svetlana A. Khlynova — C. Sc. (Med.), Assistant Professor of the Department of Obstetrics and Gynecology, Pirogov Russian National Research Medical University; 1, Ostrovityanov str., Moscow, 117997, Russian Federation, ORCID iD 0000-0003-1554-3633
Eleonora A. Markova — C. Sc. (Med.), Teaching Assistant of the Department of Obstetrics and Gynecology, Institute of Surgery, Pirogov Russian National Research Medical
University; 1, Ostrovityanov str., Moscow, 117513, Russian Federation; ORCID iD 0000-0002-9491-9303
Murad R. Ramazanov — C. Sc. (Med.), Teaching Assistant of the Department of Obstetrics and Gynecology, Institute of Surgery, Pirogov Russian National Research Medical University; 1, Ostrovityanov str., Moscow, 117513, Russian Federation.
Olga A. Slyusareva — C. Sc. (Med.), Obstetrician-Gynecologist, F.I. Inozemtsev City Clinical Hospital; 1, Fortunatovskaya str., Moscow, 105187, Russian Federation; ORCID iD 0000-0001-9279-7851
Valentina I. Dimitrova — C. Sc. (Med.), Obstetrician-Gynecologist, F.I. Inozemtsev City Clinical Hospital; 1, Fortunatovskaya str., Moscow, 105187, Russian Federation.
Nikolay A. Shevchenko — C. Sc. (Med.), Head of the Department of Gynecology, City Clinical Hospital No. 52; 3, Pekhotnaya str., Moscow, 123182, Russian Federation; ORCID iD 0000-0001-5869-367X
Contact information: Irina Yu. Il'ina, e-mail: iliyina@mail.ru
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 13.01.2025.
Revised 05.02.2025.
Accepted 28.02.2025.
References
1. Klein Meuleman S.J.M., Min N., Hehenkamp W.J.K. et al. The definition, diagnosis, and symptoms of the uterine niche — A systematic review. Best Pract Res Clin Obstet Gynaecol. 2023;90:102390. DOI: 10.1016/j.bpobgyn.2023.102390
2. Van der Voet L.F., Bij De Vaate A.M., Veersema S. et al. Long-term complications of caesarean section. The niche in the scar: a prospective cohort study on niche prevalence and its relation to abnormal uterine bleeding. BJOG. 2014;121(2):236–244. DOI: 10.1111/1471-0528.12542
3. Zulfiqar B., Perveen S., Parveen K. et al. Relationship between previous cesarean section scar, subsequent implantation of gestational sac and abnormal invasive placenta. Medical Forum Mon. 2021;32(7):58–61.
4. Gonzalez N., Tulandi T. Cesarean scar pregnancy: a systematic review. J Minim Invasive Gynecol. 2017;24(5):731–738. DOI: 10.1016/j.jmig.2017.02.020
5. Курцер М.А., Бреслав И.Ю., Колотилова М.Л. и др. Неразвивающаяся беременность в рубце на матке после кесарева сечения: сложности диагностики. Акушерство и гинекология. 2023;2:160–164. DOI: 10.18565/aig.2022.214Kurtser M.A., Breslav I.Yu., Kolotilova M.L. et al. Non-developing pregnancy in the uterine scar after caesarean section: diagnostic difficulties. Obstetrics and ginecology. 2023;2:160–164 (in Russ.). DOI: 10.18565/aig.2022.214
6. Timor-Tritsch I.E., Monteagudo A., Santos R. et al. The diagnosis, treatment, and follow-up of cesarean scar pregnancy. Am J Obstet Gynecol. 2012;207(1):44. e1–13. DOI: 10.1016/j.ajog.2012.04.018
7. Timor-Tritsch I.E., Monteagudo A. Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean section scar pregnancy; a review. Am J Obstet Gynecol. 2012;207(1):14–29. DOI: 10.1016/j.ajog.2012.03.007
8. Jurkovic D., Ben-Nagi J., Ofilli-Yebovi D. et al. Efficacy of Shirodkar cervical suture in securing hemostasis following surgical evacuation of Cesarean scar ectopic pregnancy. Ultrasound Obstet Gynecol. 2007;30(1):95–100. DOI: 10.1002/uog.4058
9. Qi F., Zhou W., Wang M.F. et al. Uterine artery embolization with and without local methotrexate infusion for the treatment of cesarean scar pregnancy. Taiwan J Obstet Gynecol. 2015;54(4):376–380. DOI: 10.1016/j.tjog.2015.01.003
10. Jordans I.P.M., Verberkt C., De Leeuw R.A. et al. Definition and sonographic reporting system for Cesarean scar pregnancy in early gestation: modified Delphi method. Ultrasound Obstet Gynecol. 2022;59(4):437–449. DOI: 10.1002/uog.24815
11. Ban Y., Shen J., Wang X. et al. Cesarean Scar Ectopic Pregnancy Clinical Classification System with Recommended Surgical Strategy. Obstet Gynecol. 2023;141:927–936. DOI: 10.1097/aog.0000000000005113
12. Буянова С.Н., Щукина Н.А., Чечнева М.А. и др. Беременность в рубце после кесарева сечения: возможности хирургической коррекции. Российский вестник акушера-гинеколога. 2020;20(6):65–70. DOI: 10.17116/rosakush20202006165Buyanova S.N., Schukina N.A., Chechneva M.A. et al. Pregnancy in the scar after cesarean section: the possibility of surgical correction. Russian Bulletin of Obstetrician-Gynecologist. 2020;20(6):65–70 (in Russ.). DOI: 10.17116/rosakush20202006165
13. Family Planning Subgroup, Chinese Society of Obstetrics and Gynocology, Chinese Medical Association. Expert opinion of diagnosis and treatment of cesarean scar pregnancy (2016). Zhonghua Fu Chan Ke Za Zhi. 2016;51(8):568–572. DOI: 10.3760/cma.j.issn.0529-567X.2016.08.003
14. Hameed M.S.S., Wright A., Chern B.S.M. Cesarean Scar Pregnancy: Current Understanding and Treatment Including Role of Minimally Invasive Surgical Techniques. Gynecol Minim Invasive Ther. 2023;19;12(2):64–71. DOI: 10.4103/gmit.gmit_116_22
15. Calí G., Timor-Tritsch I.E., Forlani F. et al. Value of first-trimester ultrasound in prediction of third-trimester sonographic stage of placenta accreta spectrum disorder and surgical outcome. Ultrasound Obstet Gynecol. 2020;55(4):450–459. DOI: 10.1002/uog.21939
16. Cali G., Forlani F., Timor-Tritsch I.E. et al. Natural history of Cesarean scar pregnancy on prenatal ultrasound: the crossover sign. Ultrasound Obstet Gynecol. 2017;50(1):100–104. DOI: 10.1002/uog.16216
17. Timor-Tritsch I.E., Monteagudo A. Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy. A review. Am J Obstet Gynecol. 2012;207(1):14–29. DOI: 10.1016/j.ajog.2012.03.007
18. Fu L., Luo Y., Huang J. Cesarean scar pregnancy with expectant management. J Obstet Gynaecol Res. 2022;48(7):1683–1690. DOI: 10.1111/jog.15258
19. Fu P., Zhang L., Zhou T. et al. Clinical Application of a New Cesarean Scar Pregnancy Classification and Evaluation System and a Risk Scoring System. Int J Gen Med. 2024;17:115–126. DOI: 10.2147/IJGM.S445327
20. Ban Y., Shen J., Wang X. et al. Cesarean Scar Ectopic Pregnancy Clinical Classification System With Recommended Surgical Strategy. Obstet Gynecol. 2023;141(5):927–936. DOI: 10.1097/AOG.0000000000005113
21. Levine D. Obstetric MRI. J Magn Reson Imaging. 2006;24(1):1–15. DOI: 10.1002/jmri.20608
22. Yang D., Zhang Z., Kang Z., Liu Y. Application and comparative analysis of 3.0T MRI and ultrasound in diagnosing CSP after caesarean section. Am J Transl Res. 2021;13(4):3806–3810. PMID: 34017569
23. Guo S., Wang H., Yu X. et al. The diagnostic value of 3.0T MRI in cesarean scar pregnancy. Am J Transl Res. 2021;13(6):6229–6235. PMID: 34306362
24. Yang F., Yang X., Jing H. et al. MRI-based scoring model to predict massive hemorrhage during dilatation and curettage in patients with cesarean scar pregnancy. Abdom Radiol (NY). 2023;48(10):3195–3206. DOI: 10.1007/s00261-023-03968-0
25. Centini G., Troia L., Lazzeri L. et al. Modern operative hysteroscopy. Minerva Ginecol. 2016;68(2):126–132. PMID: 26930389
26. Давыдов А.И., Шахламова М.Н. Недиагностированный случай беременности в рубце на матке после кесарева сечения. Вопросы гинекологии, акушерства и перинатологии. 2019;18(6):106–107. DOI: 10.20953/1726-1678-2019-6-106-107Davydov A.I., Shakhlamova M.N. An undiagnosed case of cesarean scar pregnancy. Gynecology, Obstetrics and Perinatology. 2019;18(6):106–107 (in Russ.). DOI: 10.20953/1726-1678-2019-6-106-107
27. Доброхотова Ю.Э., Белоусова Т.Н., Боровкова Е.И. и др. Консервативная тактика ведения пациенток с внематочной беременностью. Гинекология. 2023;25(4):435–441. DOI: 10.26442/20795696.2023.4.202518Dobrokhotova Yu.E., Belousova T.N., Borovkova E.I. et al. Nonsurgical management of patients with ectopic pregnancy: a review. Gynecology. 2023;25(4):435–441 (in Russ.). DOI: 10.26442/20795696.2023.4.202518
This work is licensed under a
Creative Commons «Attribution» 4.0 License.
Previous article
Next article
