Details

Autor(en) / Beteiligte

• Timor-Tritsch, Ilan E., MD
• Monteagudo, Ana, MD
• Cali, Giuseppe, MD
• Refaey, Hazem EL., MD
• Agten, Andrea Kaelin, MD
• Arslan, Alan A., MD

Titel

Easy sonographic differential diagnosis between intrauterine pregnancy and cesarean section scar pregnancy in the early first trimester

Ist Teil von

• American journal of obstetrics and gynecology, 2016

Erscheinungsjahr

2016

Link zum Volltext

Quelle

Elsevier ScienceDirect Journals

Beschreibungen/Notizen

• Abstract Background Cesarean scar pregnancy is a serious complication of pregnancy, which consists of implantation of the gestational sac in the hysterotomy scar. This condition is increasing in frequency and often poses a diagnostic challenge. Its diagnosis is dependent on visual assessment of the uterus on the longitudinal sagittal ultrasound plane. Misdiagnosing a low intrauterine chorionic sac as a cesarean scar pregnancy, or a true scar pregnancy as an intrauterine pregnancy may lead to adverse outcomes including hysterectomy. Objective The objective of the study is to describe a sonographic method for the differential diagnosis of cesarean scar pregnancy versus intrauterine pregnancy in early gestation. The current study addressed to test the hypothesis that on a first-trimester ultrasound performed between 5 and 10 weeks of gestation, the relative location of the center of gestational sac to the midpoint of the uterus along a longitudinal line between the external cervical os and the fundus, can be used for early detection of cesarean scar pregnancies. Study Design This is a retrospective review of electronically archived ultrasound images of intrauterine and cesarean scar pregnancies between 5 and 10 weeks of gestation. A total of 242 ultrasound images were analyzed: 185 cases of normal intrauterine pregnancies (including 128 in anteverted uteri, 31 in retroverted uteri and 26 intrauterine pregnancies with history of previous cesarean delivery) and 57 cases of cesarean scar pregnancies diagnosed throughout 2004-2015 in a single institution. The following measurements were made for each case: distance from the external cervical os to the uterine fundus, the midpoint axis of the uterus, the distance from the external cervical os to the center of gestational sacs and the distance from the external cervical os to the most distant edge of the gestational sacs from the cervix. Results The location of the center of the gestational sac relative to the midpoint axis of the uterus between 5 and 10 weeks of gestation differentiated between intrauterine and cesarean scar pregnancies (mean, 17.8 vs -10.6 mm, respectively, p = 0.0001), indicating that most of the cesarean scar pregnancies are located proximally to the midpoint axis of the uterus whereas most of the normal intrauterine pregnancies are located distally from the midpoint of the uterus. Using location of the center of the gestational sac as a marker of cesarean scar pregnancies between 5 and 10 weeks of gestation yielded the following characteristics of diagnostic accuracy: sensitivity 93.0% and specificity 98.9%. The likelihood ratio of the positive test was 84.5. The likelihood ratio of the negative test was 0.07. Conclusions The location of the center of the gestational sac relative to the midpoint axis of the uterus can be used as an easy, method for sonographic differentiation of intrauterine and cesarean scar pregnancies between 5 and 10 weeks of gestation.