- Joined
- Sep 7, 2024
Medfag here, I mostly see ectopics in the ovary itself or most often in the fallopian tubes (but it just looks like the ectopic is floating out in the ligaments of the uterus, so we generally call it an adnexal [general uterine area] ectopic). The main reason we try to limit moms to 4 c-sections and a limited amount of VBAC (vaginal birth after cesarian) is because of what's going on with Goodings, a CSP.Goodings has had a bunch of miscarriages, which I think is driving her decision-making here. It's especially odd considering Orthodox church law allows for termination in case of an ectopic pregnancy. It's also interesting that the pregnancy is located in her c-section scar tissue, not in her fallopian tube. I had no idea that could happen.
The frequency of cesarean scar pregnancy is reported to be 1:1,800 to 1:2,226 (0.05–0.04%) of all pregnancies. In women after a cesarean section, the frequency of CSP is approximately 0.15%, which constitutes 6.1% of all ectopic pregnancies in patients after at least one cesarean operation(3). (NIH)
The doctors will always, always, recommend strongly that the mother terminate for her safety in the case of any ectopic but especially in this case. It's the most dangerous kind of ectopic by far.
"The gestational outcome was described in 194 patients. Out of these, 39 patients (20,1%) had a miscarriage and 16 (8,3%) suffered foetal death. 50 patients had a term delivery (25,8%) and 81 (41,8%) patients had a preterm birth, out of which 27 (13,9%) delivered before 34 weeks of gestation; 25 cases were known to be emergent deliveries, most of them due to severe haemorrhage and 102 (52,6%) patients had a hysterectomy (10 elective versus 92 emergent). All live births had a caesarean delivery, except for one case of vaginal delivery....From our review, cases of CSP had a high rate of relevant morbidity: foetal death, preterm birth (including under 34 weeks), blood loss, hysterectomies, and surgical complications; but particularly higher in CSP with PAS. The presence of PAS has been linked to more unfavourable obstetric outcomes, and even within the spectrum, cases of more severe PAS are linked to more morbidity."
Note: PAS is placenta accreta spectrum; when the placenta implants too deeply in the uterus and thus has more difficulty detaching after labor. This can lead to hemhorrage.
The three kinds of PAS:
Placenta accreta: The placenta grows into the uterine lining and does not separate easily at delivery.
Placenta increta: The placenta grows into the muscle of the uterine wall.
Placenta percreta: The placenta grows through the uterine wall and may grow into other organs.
Placenta accreta: The placenta grows into the uterine lining and does not separate easily at delivery.
Placenta increta: The placenta grows into the muscle of the uterine wall.
Placenta percreta: The placenta grows through the uterine wall and may grow into other organs.
Cesarean Scar Pregnancy: A systematic review on expectant management
Silva, Beatriz et al.European Journal of Obstetrics and Gynecology and Reproductive Biology, Volume 288, 36 - 43



