Uterine Artery Embolization for Caesarean Scar Pregnancy (CSP)

Dr.Abhishek Bansal, 3 mins read

Caesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy (EP), a condition where the embryo attaches and starts developing outside the uterine cavity. Although EPs most frequently occur in the fallopian tube, they can happen at the site of a previous C-section scar as well. This is called caesarean scar ectopic pregnancy (CSEP).

The frequency of CSP has been increasing with an increase in the number of caesarean sections (C-sections) being performed globally.

Usually, a CSP shows no symptoms but some women may experience vaginal bleeding or mild abdominal pain. Its main causes include previous C-sections, uterine surgeries, conditions affecting the shape of the uterus, assisted reproductive technology (ART) and older maternal age.

In most cases, the embryo does not develop a heartbeat or cannot grow safely. In that condition, the embryo must be medically or surgically removed. In rare cases, even when the embryo has a heartbeat, the pregnant woman has the option to terminate the pregnancy and save herself from potential complications.

If she decides to proceed with the pregnancy, she can face significant risks, including severe internal bleeding (haemorrhage), preterm labour and uterine rupture. So, it’s important not to ignore this problem and consult your doctor before taking any significant steps.

Diagnosis:

As CSP usually doesn't produce any noticeable symptoms until it turns into any complication, it is crucial to follow some steps cautiously, especially if you have had a prior caesarean section.

Get an ultrasound done within 8 weeks of a positive pregnancy test. During the report analysis, share your C-section history with the doctor so he/she can check each important aspect.

A low, anteriorly located embryo/gestational sac can be an indication of caesarean scar pregnancy. Your doctor may also look for other indications. If needed, they may suggest other tests as well like transvaginal ultrasound for more clarity.

Treatment:

Patients with caesarean scar pregnancies can be managed by:

• Surgery: This includes laparoscopic or transvaginal resection of the CSEP.
• Medical treatment: You’ll be given a local or intragestational injection of a drug called methotrexate.
  Note: both the above treatments may lead to catastrophic haemorrhage and may further require removal of the whole uterus to control such bleeding.
• Uterine artery embolisation: UAE is one of the preferred approaches to treat caesarean scar ectopic pregnancy. It can be used as a stand-alone procedure or in combination with other treatment options.

Uterine artery embolisation is a safe, minimally invasive and non-surgical treatment for numerous uterine conditions. In this procedure, an interventional radiologist uses imaging guidance to insert a catheter through the femoral/radial artery.

Once the catheter reaches the targeted area, it releases embolic agents to block blood flow to the placental tissue implanted in the uterine scar. This causes embryo demise and resolves vaginal bleeding and other symptoms.

Compared to surgical and medical treatment, the UAE has shown more promising results; it has a high success rate and low complication rate in ectopic pregnancy, including CSP. It may control haemorrhage and preserve the uterus for future pregnancy. Consult a doctor today for uterine artery embolization.