How to treat pregnancy stuck on old cesarean scar

The article is professionally consulted by Master, Doctor Trinh Thi Thanh Huyen - Department of Obstetrics and Gynecology - Vinmec Hai Phong International General Hospital.

Fetus clinging to the old cesarean section is a rare obstetric pathology. The pregnancy implanted on the old incision cannot be kept because the larger the fetus, the higher the risk of uterine rupture, even affecting the mother's life. Therefore, early detection and treatment help prevent serious complications.

C-section scar pregnancy is a serious obstetric complication, this is an ectopic pregnancy caused by the pregnancy implanting at the incision scar on the uterine muscle. Fetal implantation at the old incision site is the rarest pathology of ectopic pregnancy. However, with the increasing rate of cesarean section, the percentage of fetuses attached to the old incision also increased.
Pregnancy on uterine scars causes many dangerous complications for pregnant women: placenta, uterine rupture, massive bleeding, invasion of placenta into bladder, high risk of hysterectomy, increased rate of pregnancy. death rate. Pregnancy implanted on the old incision cannot be preserved because the larger the fetus, the higher the risk of uterine rupture. Therefore, for women who have had a cesarean section, when having a second pregnancy, it is necessary to have an early examination to determine the exact position of the fetus. Early detection of pregnancy clinging to the old incision helps to preserve fertility for the patient.

2.1. Clinical diagnosis
About one-third of patients with pregnancy clinging to the old incision have no symptoms, most have 3 common symptoms:
Missed period. Abnormal vaginal bleeding. Stomach ache. 2.2. Laboratory tests
Vaginal ultrasound combined with Doppler 3D ultrasound (non-routine) MRI (non-routine) helps diagnose in difficult cases.

The aim of the treatment of pregnancy attached to the old cesarean scar is to remove the fetus as soon as possible before rupture and preserve the mother's fertility. The choice of treatment depends on the gestational age, the size of the gestational sac, the hemodynamic status, and the patient's desire to preserve reproductive function. Treatment is often combined with multiple modalities depending on the specific patient's condition.
3.1. Abortion in the amniotic sac
Abortion in the amniotic sac is indicated for fetuses that already have fetal cardiac activity. The procedure of abortion by aspiration of the gestational sac is performed in the operating room under the guidance of ultrasound. This procedure is done through the cervix and vagina.
3.2. Placental block removal
The two classic modalities of placental mass removal are dilation and surgery.
Dilation and curettage : The disadvantage of this method is the high risk of bleeding. Placental mass aspiration can be performed when β-hCG is greatly reduced (to 10-30% of baseline). Curing is often combined with other mechanical modalities (anterior uterine artery ligation, post curettage balloon insertion) to reduce the risk of bleeding. Surgery: the purpose of this method is to remove the pregnancy mass, preserve the uterus or remove the uterus. Surgery to remove the placental mass is indicated in case the patient does not respond to internal therapy, the placental mass is invasive. The benefit of surgery is to remove all placental tissue and at the same time repair the defect of the old surgical scar and prevent recurrence. The disadvantage of this method is that the incision is long, the postoperative period is long, and there is an increased risk of placenta previa and placenta accreta. Hysterectomy from the beginning can also be applied in the following cases:
Maternal bleeding that cannot be stopped. Pregnancy in the second or third trimester. Avoid having a blood transfusion or being in an emergency situation in women who are not in need of a baby. Gestational age on ultrasound is about 12 weeks. 3.3. Insertion (tamponade)
The purpose of this procedure is to control bleeding after aspiration.
3.4. Systemic chemotherapy
This method can be the first treatment or supportive treatment, to reduce the distribution of blood vessels in the fetal mass, to destroy placental cells. Before proceeding with systemic chemotherapy, the patient was assigned to have blood tests, liver and kidney function tests.
3.5. Blood vessel occlusion
Used in preparation for a procedure or surgery or in combination with chemotherapy. The methods used are:
Vaginal uterine artery ligation. Ligation of the internal iliac artery. Occlusion of the cervix, uterus, or internal iliac artery.

After surgery, the uterus is still weak, so a woman should not get pregnant again too soon, it is best to be at least 1 year before surgery. If you are pregnant again, you need regular prenatal visits to ensure a healthy pregnancy for both mother and baby.
In summary, with women who have been diagnosed with pregnancy at the old caesarean section, it is necessary to perform a removal of the fetus. Depending on each specific case, the desire to preserve the patient's reproductive function, the doctor will make an appropriate treatment option.
At Vinmec International General Hospital, there is a package maternity service as a solution to help pregnant women feel secure because of the companionship of the medical team throughout the pregnancy. When choosing Maternity Package, pregnant women can:
The pregnancy process is monitored by a team of qualified doctors Regular check-up, early detection of abnormalities Maternity package helps to facilitate the process. Childbirth program Newborns receive comprehensive care Master. Trinh Thi Thanh Huyen is highly trained in obstetric ultrasound, laparoscopic surgery and hysteroscopy at the National Hospital of Obstetrics and Gynecology and has more than 13 years of experience working at Hai Phong Obstetrics and Gynecology Hospital.
Currently, the doctor is an Obstetrician and Gynecologist at Vinmec Hai Phong International General Hospital

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