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Advisor(s)
Abstract(s)
Introdução: Gravidez com implantação na cicatriz de cesariana anterior é um tipo de gravidez
ectópica cada vez mais prevalente, devido ao aumento de cesarianas realizadas em todo o
mundo. Tem uma incidência que varia entre 1:1800 a 1:2216 de todas as gravidezes e
corresponde a 6,1% das gravidezes ectópicas em pacientes que realizaram pelo menos uma
cesariana. Caracteriza-se, habitualmente, por uma implantação na cicatriz de cesariana
anterior, devido a defeitos na correta cicatrização da mesma. É diagnosticada através da
presença de antecedentes de cesariana prévia, com base nos níveis de ß-hCG e de acordo com
os achados ecográficos identificados. Está associada a um elevado risco de efeitos adversos
tais como hemorragia severa, rotura uterina e histerectomia.
Objetivos: Esta dissertação tem como intuito abordar os diferentes métodos terapêuticos da
gravidez com implantação na cicatriz de cesariana anterior, dando destaque ao tratamento
expectante, com o objetivo de compreender a possibilidade de gerar um feto viável através
desta gravidez ectópica, mas também perceber como se pode uniformizar as técnicas
terapêuticas entre os diferentes especialistas.
Metodologia: Foi efetuada pesquisa bibliográfica na plataforma PubMed entre setembro de
2021 e março de 2022.
Resultados: Apesar desta condição ser relativamente incomum, existem diversos estudos
sobre as melhores técnicas terapêuticas e abordagens perante os casos de gravidez de cicatriz
de cesariana, distinguindo-se terapêuticas médicas, cirúrgicas e expectantes tanto para
gravidezes evolutivas como para gravidezes não evolutivas. Em grávidas
hemodinamicamente estáveis é aconselhado tratamento médico ou minimamente invasivo e,
caso as gestantes não queiram interromper a gravidez, é tentado o tratamento expectante,
explicando os riscos e efeitos adversos associados à continuação desta gravidez ectópica.
Histerectomia é uma abordagem cirúrgica utilizada geralmente em último caso, em doentes
que se apresentam com instabilidade hemodinâmica.
Conclusão: A gravidez com implantação na cicatriz de cesariana anterior tem cada vez mais
importância para a comunidade médica, tendo aumentado os conhecimentos sobre a sua
patogénese, diagnóstico e tratamento, verificando-se a necessidade de estabelecer critérios
uniformes para o seguimento e tratamento destas gravidezes ectópicas.
Introduction: Caesarean scar pregnancy is an increasingly prevalent type of ectopic pregnancy, consequence of the increase in caesarean sections performed worldwide. It has an incidence between 1:1800 to 1:2216 of all pregnancies and corresponds to 6.1% of ectopic pregnancies in patients who underwent at least one caesarean section. It is usually characterized by implantation in the scar of a previous caesarean section, due to defects in its correct healing. The diagnostic is made through the presence of a history of previous caesarean section, based on the levels of ß-hCG and according to the ultrasound findings. It is associated with a high risk of adverse effects such as severe bleeding, uterine rupture and hysterectomy. Objectives: This dissertation aims to approach the different therapeutic methods of caesarean scar pregnancy emphasizing the expectant treatment, understanding the possibility of generating a viable fetus through this ectopic pregnancy, and also understanding how to standardize therapeutic techniques among different specialists. Methodology: The literature review was based on the PubMed platform between September 2021 and March 2022. Results: Although this condition is relatively uncommon, there are several studies on the best therapeutic techniques and approaches in cases of caesarean scar pregnancy, distinguishing medical, surgical and expectant therapies for both evolving and nonprogressive pregnancies. In hemodynamically stable pregnant women, medical or minimally invasive treatment is recommended and, if pregnant women do not want to terminate the pregnancy, expectant treatment should be tried, explaining the risks and adverse effects associated with the continuation of this ectopic pregnancy. A hysterectomy is a surgical approach generally used as a last resort, in patients who present with hemodynamic instability. Conclusion: Caesarean scar pregnancy is increasingly highlighted by the medical community, having increased knowledge about its pathogenesis, diagnosis and treatment, verifying the need to establish uniform criteria for the follow-up and treatment of these ectopic pregnancies.
Introduction: Caesarean scar pregnancy is an increasingly prevalent type of ectopic pregnancy, consequence of the increase in caesarean sections performed worldwide. It has an incidence between 1:1800 to 1:2216 of all pregnancies and corresponds to 6.1% of ectopic pregnancies in patients who underwent at least one caesarean section. It is usually characterized by implantation in the scar of a previous caesarean section, due to defects in its correct healing. The diagnostic is made through the presence of a history of previous caesarean section, based on the levels of ß-hCG and according to the ultrasound findings. It is associated with a high risk of adverse effects such as severe bleeding, uterine rupture and hysterectomy. Objectives: This dissertation aims to approach the different therapeutic methods of caesarean scar pregnancy emphasizing the expectant treatment, understanding the possibility of generating a viable fetus through this ectopic pregnancy, and also understanding how to standardize therapeutic techniques among different specialists. Methodology: The literature review was based on the PubMed platform between September 2021 and March 2022. Results: Although this condition is relatively uncommon, there are several studies on the best therapeutic techniques and approaches in cases of caesarean scar pregnancy, distinguishing medical, surgical and expectant therapies for both evolving and nonprogressive pregnancies. In hemodynamically stable pregnant women, medical or minimally invasive treatment is recommended and, if pregnant women do not want to terminate the pregnancy, expectant treatment should be tried, explaining the risks and adverse effects associated with the continuation of this ectopic pregnancy. A hysterectomy is a surgical approach generally used as a last resort, in patients who present with hemodynamic instability. Conclusion: Caesarean scar pregnancy is increasingly highlighted by the medical community, having increased knowledge about its pathogenesis, diagnosis and treatment, verifying the need to establish uniform criteria for the follow-up and treatment of these ectopic pregnancies.
Description
Keywords
Diagnóstico Gravidez em Cicatriz de Cesariana Tratamento Tratamento Expectante