National Taiwan University Hospital’s (NTUH) Department of Obstetrics and Gynecology has helped three mothers with caesarean scar ectopic pregnancies give birth safely while preserving their uterus.
One-third of the mothers in Taiwan choose Caesarean deliveries, which means that they have a one-in-2,000 chance of experiencing what is known as a caesarean scar ectopic pregnancy if they become pregnant again.
An ectopic pregnancy usually happens in the oviduct or the ovary, with a 1 percent rate of occurrence, department director Chen Shee-uan (陳思原) said on Friday.
Photo: Yang Yuan-ting, Taipei Times
Caesarean scar ectopic pregnancy occurs when an embryo implants in the scar of the previous caesarean section, she said.
Women often choose to terminate such pregnancies to avoid the risk of uterine rupture, she said.
Chen cited the example of a woman who ended one such pregnancy, but when the complication occurred again, she and her husband decided to give birth to the child after consulting with the team at the NTUH.
Having one caesarean scar ectopic pregnancy raises the chance of it happening again, an NTUH physician said.
The woman gave birth to a healthy baby girl in the 30th week.
During the birth, the team controlled bleeding using a technique called resuscitative endovascular balloon occlusion of the aorta along with a Nausicaa suture, NTUH obstetrician Tai I-yun (戴怡芸) said.
Nausicaa suture is a technique developed by Shih Jin-chung (施景中), an obstetrician in the department, in 2013, she said.
With assistance from the divisions of neonatology and cardiology, along with the departments of anesthesiology and urology, the baby was born and the mother’s uterus was preserved, she said.
Of more than 100 caesarean scar ectopic pregnancies seen in the hospital, most women chose to end their pregnancies, while three mothers have successfully given birth, Shih said.
One of those mothers experienced phenomena known as placenta praevia and another had placenta accreta, which put their uterus at risk, but all three were preserved by the Nausicaa suture, he said.
The American Medical Association advises women with caesarean scar ectopic pregnancy to remove their uterus, which might not be necessary with the technique used at NTUH, Shih said.
The Nausicaa suture procedure does not require much technical ability, he said, adding that he hopes it can be adopted by healthcare systems in other countries.
Although the odds of a caesarean scar ectopic pregnancy are low, Shih suggested that women choose a natural birth whenever possible to avoid risks.
The treatment was published in the American Journal of Obstetrics and Gynecology.
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