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

• Published in: American journal of obstetrics and gynecology Vol. 207; no. 1; pp. 14 - 29
• Main Authors: Timor-Tritsch, Ilan E., MD, Monteagudo, Ana, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.07.2012; Elsevier
• Subjects: Biological and medical sciences; Cesarean Section - trends; cesarean section pregnancy; Cicatrix; Delivery. Postpartum. Lactation; Diseases of mother, fetus and pregnancy; Disorders; early pregnancy; ectopic pregnancy in the cesarean section; Female; Gynecology. Andrology. Obstetrics; Humans; Medical sciences; Obstetrics and Gynecology; Placenta Accreta - diagnosis; Placenta Accreta - etiology; Placenta Accreta - therapy; Postoperative Complications - diagnosis; Postoperative Complications - therapy; Pregnancy; Pregnancy, Ectopic - diagnosis; Pregnancy, Ectopic - etiology; Pregnancy, Ectopic - therapy; Pregnancy. Fetus. Placenta; Treatment Outcome; ultrasound; United States; United States; ectopic pregnancy in the cesarean section; cesarean section pregnancy; early pregnancy; ultrasound; pregnancy; Sonography; Pregnancy disorders; Scar; Gynecology; Review; Placenta diseases; Obstetrics; Placenta accreta; Obstetrical technique; Treatment; Surgery; Delivery disorders; Early pregnancy; Early; Ectopic pregnancy; Ultrasound; Cesarean section; Bibliographic review
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2012.03.007

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. We explored their clinical and diagnostic as well as therapeutic similarities. We 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.