Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy.

                                                                                                                                    

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.