Affordable Access

Access to the full text

Expectant management of caesarean scar ectopic pregnancy: a systematic review

Authors
  • Jayaram, Pradeep
  • Okunoye, Gbemisola
  • Al Ibrahim, Abdullah Awad
  • Ghani, Rauf
  • Kalache, Karim
Type
Published Article
Journal
Journal of Perinatal Medicine
Publisher
Walter de Gruyter GmbH
Publication Date
Nov 08, 2017
Volume
46
Issue
4
Pages
365–372
Identifiers
DOI: 10.1515/jpm-2017-0189
Source
De Gruyter
Keywords
License
Yellow

Abstract

Aim: The purpose of this review is to systematically review all the reported cases and case series of caesarean scar pregnancy (CSP) managed expectantly without any intervention in order to understand the outcomes of pregnancy which will guide clinicians and patients in making treatment choices. Methods: An electronic search on PubMed, EMBASE and Cochrane databases and a manual search from references of the articles were performed. Studies were selected based on inclusion and exclusion criteria. Data were extracted for various outcomes of pregnancy and the quality of the reports was assessed using a modified Delphi technique. Results: A total of 56 cases of CSP from 11 reports were included in the review, including 44 cases with foetal cardiac activity. Live births were achieved in 73% of cases with a quarter of them born before 34 weeks. Hysterectomy rates were 70%. In 12/44 (27%) of cases pregnancies were lost due to complications before 24 weeks. Most (67%) of the CSPs with no foetal cardiac activities resolved on expectant management and the remaining required intervention for bleeding. Conclusions: Caution should be exercised when choosing expectant management in cases of viable CSPs, and if chosen, the patient should be counselled adequately for possible outcomes including loss of pregnancy and hysterectomy. Expectant management is acceptable in CSPs with no foetal cardiac activity. There is a need for prospective research on this topic with adequate reporting on possible prognostic markers, as well as a need to improve on the techniques to prevent loss of fertility during delivery.

Report this publication

Statistics

Seen <100 times