Clinical and morphological features of the cesarean scar pregnancy

Clinical case

Authors

DOI:

https://doi.org/10.18370/2309-4117.2022.65.67-70

Keywords:

uterine scar, placenta percreta, ectopic pregnancy, myometrium

Abstract

The features of timely diagnosis and possible risks of the cesarean scar pregnancy are demonstrated on the example of a clinical case.
This article presents analysis of pregnancy and childbirth of patient Sh., who was in the Obstetrics Department of the Kyiv City Maternity Hospital No. 1, as well as the results of a detailed morphological study of tissue characteristics during pregnancy in the scar on the uterus.
A complete presentation of the chorion with localization in the area of the postoperative scar and a defect in the uterine wall was established at the first and second ultrasound screening. The woman was informed about pregnancy risks, but she insisted on prolonging the pregnancy. A planned surgical intervention was performed in the period of 36–37 weeks. A bottom caesarean section was performed and a girl weighing 3610 g, height 55 cm was removed. Intraoperatively confirmed deformation with a defect of the front uterus wall in the area of a postoperative scar measuring 10 × 12 cm, filled with placental tissue in the form of aneurysmal altered vessels. It was confirmed that placenta grew into the wall of the uterus over the entire area of its location, which occupied the entire lower segment on the entire circumference of the uterine body. At the same time, a significant deformation of the front and back walls of the uterus was noted. Morphological examination revealed hypoxic degenerative changes in the placenta, from the side of the parietal plate, with sclerosis, hyalinosis and deposition of fibrinoid in the villi, as well as the presence of hemorrhages, petrifications and the formation of conglomerates and bridges between them.
Conclusions. It was founded the leading role in the mechanism of formation of atypical localization of pregnancy in the area of the scar after previous cesarean section was altered uterus tissue, where implantation occurred. There is a high probability of transition from ectopic pregnancy to scarring from liquid forms of ectopic pregnancy in the category of more frequent pathologies due to the increase in the frequency of cesarean sections.

Author Biographies

N.P. Honcharuk, P.L. Shupyk National Healthcare University of Ukraine; Municipal Non-Profit Enterprise “Kyiv City Maternity Hospital No. 1”, Kyiv

MD, associate professor, Obstetrics, Gynecology and Perinatology Department;
Director

O.O. Diadyk, P.L. Shupyk National Healthcare University of Ukraine, Kyiv

MD, professor, head of the Department of Pathological and Topographic Anatomy

N.R. Kovyda, Municipal Non-Profit Enterprise “Kyiv City Maternity Hospital No. 1” , Kyiv

PhD, obstetrician-gynecologist

O.Y. Lysenko, Municipal Non-Profit Enterprise “Kyiv City Maternity Hospital No. 1”, Kyiv

ScD, associate professor, deputy director for organization, scientific and methodological work

O.B. Shelest, Kyiv Regional Clinical Hospital, Kyiv

Pathologist, Pathomorphology Department

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Published

2022-08-09

How to Cite

Honcharuk, N., Diadyk, O., Kovyda, N., Lysenko, O., & Shelest, O. (2022). Clinical and morphological features of the cesarean scar pregnancy: Clinical case. REPRODUCTIVE ENDOCRINOLOGY, (65), 67–70. https://doi.org/10.18370/2309-4117.2022.65.67-70

Issue

No. 65 (2022)

Section

Pregnancy and childbirth

License

Copyright (c) 2022 Н.П. Гончарук, О.О. Дядик, Н.Р. Ковида, О.Ю. Лисенко, О.Б. Шелест

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