August 22nd, 2019

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Dichorionic Diamniotic Cesarean Scar Pregnancy Resulting in Live Twin Birth: 319 A Case Report
Authors:  Sayaka Matsueda, M.D., Nobuhiro Hidaka, M.D., Ph.D., Yukiko Kondo, M.D., and Kiyoko Kato, M.D., Ph.D.
BACKGROUND: Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy. Early termination is commonly performed for fear of massive bleeding and uterine rupture. Only a few cases of CSP continuation resulting in viable delivery have been reported, and almost all of these were singleton pregnancies.

CASE: We present a rare case of CSP and successful dichorionic, diamniotic (DD) twin delivery. A 32-year-old woman who had undergone 2 previous cesarean deliveries was diagnosed with DD twins and CSP. She experienced genital bleeding and threatened preterm labor; we managed the complications with blood transfusion and aggressive tocolytic therapy. At 29 weeks and 3 days’ gestation the patient experienced active bleeding and regular uterine contractions, and we performed an emergency cesarean delivery. The patient required a hysterectomy for uncontrolled intraoperative bleeding. The twins weighed 1,480 g and 656 g and followed a favorable postnatal course without any severe complications. Both twins survived to hospital discharge.

CONCLUSION: Our experience suggests that live birth is achievable even in twin CSP. Because CSP is frequently associated with placenta previa and placenta accreta, such patients must be managed carefully.
Keywords:  cesarean hysterectomy, cesarean scar, cesarean scar pregnancy, diamniotic, dichorionic, ectopic pregnancy, placenta acreta, twin pregnancy
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