20–24 October 2018, Singapore
Other two cases are mass-based Caesarean scar pregnancy (CSP)
with and without curettage, with a heterogeneous lesion detected
in the anterior wall at the lower segment uterus. In all these cases,
fast accumulation of contrast agents along with high intensity in
the lesion and myometrium nearby are observed by intravenous
CEUS; continuous perfusion was also detected between lesion and
myometrium in the scar. The features of intramural pregnancy
by intravenous CEUS was that an obvious supply vessel could be
seen in the myometrium nearby the gestational sac during early
enhancement stage. The agent was unevenly high accumulated
in the two cases of mass-based CSP. For the 2nd case with
incompletely abortion, After uterine artery embolisation (UAE),
spiral enhancement still can be demonstrated in the mass. The
patient received hysteroscopy and curettage at last. In the 3rd case,
the shapes of enhancement area were demonstrated like branches
and mamillary. The mass showed no enhancement after UAE. Two
month later, the mass disappeared in the follow-up visit.
Conclusions: The intravenous CEUS can provide blood perfusion
evidence of SP, ascertain the blood supply vessel, clarify the perfusion
pattern of the lesion, and precisely identify the implantation site of
the embryo. It can also improve the diagnostic accuracy rate, estimate
therapeutic effect and show more important diagnostic information
for clinical treatment followed.
EP17: EARLY PREGNANCY DEVELOPMENT
AND PLACENTATION
EP17.01
Caesarean scar defects: critical appraisal
M.S. Elsedeek
Obstetrics and Gynecology, Alexandria University, Alexan-
dria, Egypt
Objectives: To critically appraise literature about isthmocele
including sonographic diagnosis, clinical correlation, and suggested
treatment options.
Methods: Review and criticism of the literature.
Results: All of the available literature represent case series and case
reports with serious concerns about methodology and conclusions.
Conclusions: Isthmocele is sonographic term with doubtful clinical
impact and interventions done for its repair should be reconsidered.
EP17.02
Abstract withdrawn
EP17.03
Echographic aspects of Caesarean scars in non-pregnant
uterus after single or multiple Caesarean sections
C. Ionescu2 , P. Liana1 , D. Gheorghiu2 , A. Matei2 ,
M.T. Dimitriu2
1
Bucur Maternity, Carol Davila University of Medicine and
Pharmacy, Bucharest, Romania; 2 Obstetrics and Gynecol-
ogy, UMF Carol Davila, Clinical Hospital St Pantelimon,
Bucharest, Romania
Objectives: To establish an association between echographic
parameters of the Caesarean scar in non-pregnant uterus and the
number of previously performed Caesarean sections.
© The Authors 2018
© Ultrasound in Obstetrics & Gynecology 2018; 52 (Suppl. 1): 194–276.
Electronic poster abstracts
Methods: The study group include 110 non-pregnant women with
a history of low transverse Caesarean section with single or 2
layer uterine closure. The transvaginal ultrasound was performed to
establish the parameters of the Caesarean scar: the thickness of the
tissue scar segment, the triangular shaped anechoic scar defect.
Results: The Caesarean scar section was evidence with transvaginal
ultrasound. In 98,4% of cases the scar was identified. In 24,4%
of cases the completely hysterotomy scar tissue was identified. In
75,5 % of cases an anechoic triangle identified as scar defect, was
observed. The thickness of the tissue scar segment varies with the
number of Caesarean section.
Conclusions: The mean thickness after a single Caesarean section
was 10,1 mm, after two Caesarean section was 8,1 mm and after
3 Caesarean section was 4,4 mm. We identified the basis of the
triangle (P) and the height of the triangle (W) and we made the index
thickness/basis and thickness/height of triangle.
EP17.04
Abstract withdrawn
EP17.05
Management of Caesarean scar ectopic pregnancy in a semi
urban referral centre in South India (Tamil Nadu): a case
series
U. Sennaiyan1,2 , S. Singaravelu2
1
Westmead, NSW, Australia; 2 Obstetrics and Gynecology, RK
Hospitals, Thanjavur, Tamil Nadu, India
Objectives: To describe the early ultrasound diagnosis and various
methods of management of Caesarean scar ectopic pregnancy (CSEP)
in a semi urban referral centre in South India.
Methods: Forty ectopic pregnancies were diagnosed at our unit
between 2015-2017. Six were confirmed to be CSEP based on the
ultrasound criteria of absence of intrauterine sac, implantation of
gestational sac in the previous LSCS scar region in the anterior
myometrium with no communication with endocervical canal, with
or without myometrial thinning and increased HCG values. The
clinical presentation and management including complications are
discussed.
Results: The six patients were referred as low implantation of
gestational sac, cervical ectopic and failed multiple curettage. The
mean gestational age was 7 weeks. Five were treated successfully
by ultrasound guided, transvaginal injection of single dose of
Methotrexate (3 patients) or Methotrexate with Potassium chloride
(2 patients) into the sac. All 5 procedures were successful, without
complications. One patient was referred after failed multiple
curettage (for suspected miscarriage) with profuse bleeding requiring
blood transfusion. CSEP was diagnosed based on review of the
ultrasound images from the referring institute. Surgical wedge
resection of the uterine scar defect was performed thus preserving
future fertility. The patients were monitored clinically and by serial
serum HCG.
Conclusions: Early diagnosis and ultrasound guided management of
CSEP is feasible and is a safe and effective treatment in a low resource
setting. Misdiagnosis could potentially lead to complications like
profuse bleeding leading to hysterectomy.
Supporting information can be found in the online
version of this abstract
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