Trudnoća u ožiljku carskog reza

master's thesis

• Title (english): Cesarean scar pregnancy
• Author: Tonja Haničar
• Mentor: Lana Škrgatić (mentor)
• Committee member: Vesna Elveđi Gašparović (predsjednik povjerenstva)
• Committee member: Dinka Pavičić Baldani (član povjerenstva)
• Committee member: Lana Škrgatić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Trudnoća u ožiljku carskog reza je poremećaj implantacije koji se javlja kao komplikacija prethodnog carskog reza. Zbog povećane učestalosti carskog reza, ali i boljih dijagnostičkih mogućnosti, bilježi se porast incidencije. Točan mehanizam nastanka je još uvijek nepoznat, no poznato je da su prethodne intervencije na maternici jedan od glavnih rizičnih čimbenika. Trudnice s trudnoćom u ožiljku mogu biti asimptomatske i slučajno se otkriti rutinskim ultrazvučnim pregledom ili se manifestiraju vaginalnim krvarenjem i/ili bolovima u abdomenu. Transvaginalni ultrazvuk je zlatni standard u dijagnostici, a magnetska rezonanca se koristi u kompliciranim slučajevima kada je potrebno bolje definirati odnose sa okolnim tkivima.
Ne postoji jedinstveni stav o najučinkovitijoj metodi liječenja trudnoće u ožiljku carskog reza. Cilj liječenja je dovršiti trudnoću i spriječiti komplikacije te očuvati plodnost. Od medikamentoznih metoda najčešća je lokalna primjena metotreksata, samostalno ili u kombinaciji s nekom drugom metodom. U kirurške metode spadaju: sukcijska kiretaža, embolizacija uterine arterije, histeroskopija, transvaginalna ekscizija te laparoskopska ekscizija. Također je moguće istovremeno primjenjivati kombinacije različitih metoda kako bi se postigao što bolji ishod. Kod trudnica koje odluče nastaviti trudnoću moguće je rađanje živorođenog djeteta, ali s visokom stopom komplikacija zbog rupture uterusa, urasle posteljice i histerektomije koja trajno oduzima reproduktivnu sposobnost ženi.
Cilj ovog rada je prikazati poremećaje implantacije te posebnu pozornost posvetiti trudnoći u ožiljku carskog reza kako bi se ukazalo na potrebu rane dijagnostike i široki raspon mogućih intervencija.

Abstract (english)

Cesarean scar pregnancy is an implantation disorder that appears as a complication of a previous Cesarean section. Because of the increased incidence of Caesarean sections, but also better diagnostic capabilities, an increase in incidence has been reported. The exact mechanism of occurrence is still unknown, but what is known is that previous uterine interventions are one of the major risk factors. Pregnant women with Cesarean scar pregnancy can be asymptomatic and accidentally detected by a routine ultrasound examination, or may present with vaginal bleeding and / or abdominal pain. Transvaginal ultrasound is the gold standard in diagnosis, and magnetic resonance imaging is used in complicated cases where it is necessary to better determine relationships with surrounding tissues.
There is no unified stand on the most effective treatment of Cesarean scar pregnancy. The aim of the treatment is to terminate the pregnancy and prevent complications, as well as preserve fertility. The most common medical treatment is local methotrexate, alone or in combination with another method. The surgical methods include: suction curettage, uterine artery embolization, hysteroscopy, transvaginal excision and laparoscopic excision. It is also possible to simultaneously apply a combination of different methods to achieve a better result. For pregnant women who decide to continue their pregnancy it is possible to have a live-born baby, but with a high rate of complications due to uterine rupture, placenta accreta spectrum, and hysterectomy, which results in a permanent loss of reproductive ability.
The aim of this paper is to show implantation disorders and pay special attention to Cesarean scar pregnancy to indicate the need for early diagnosis and a wide range of possible interventions.

• Keywords: poremećaji implantacije; trudnoća u ožiljku carskog reza; ultrazvuk; liječenje
• Keywords (english): implantation disorders; Caesarean scar pregnancy; ultrasound; treatment
• Language: croatian
• URN:NBN: urn:nbn:hr:105:742413
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2020-03-02 14:32:41