A review; Timor-Tritsch IE, Monteagudo A; American Journal of Obstetrics and Gynecology 207 (1), 14-29 (July2012) This review concentrates on 2 consequences of cesarean deliveries that
may occur in a
subsequent pregnancy. They are the pathologically
adherent placenta and the cesarean scar pregnancy. They explored their clinical and diagnostic as well as therapeutic
similarities, reviewed the literature concerning the occurrence of early placenta
accreta and cesarean section scar pregnancy.
The review resulted in several conclusions:
(1) the diagnosis of placenta accreta and cesarean scar
pregnancy is difficult;
(2) transvaginal ultrasound seems to be the best
diagnostic tool to establish the diagnosis;
(3) an early and correct
diagnosis may prevent some of their complications;
(4) curettage and
systemic methotrexate therapy and embolization as single treatments
should be avoided if possible; and
(5) in the case of cesarean scar
pregnancy, local methotrexate- and hysteroscopic-directed procedures had
the lowest complication rates.
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