A laparoscopic approach to cesarean scar ectopic pregnancy

Pickett, Charlotte; Minalt, Nicole; Higgins, Olivia; Bernard, Caitlin; Kasper, Kelly

doi:10.1016/j.ajog.2021.11.021

Cited by 8 publications

(7 citation statements)

References 7 publications

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“…While the authors conclude that the laparoscopic approach appears to be a safe and effective technique for the management of CSP, applied either as a primary intervention or after failure of medical management, they consider laparoscopic removal of CSP as mandatory when the scar gestation is growing towards the bladder and abdominal cavity (type II CSP) [37]. Laparoscopic excision of CSP up to 11 weeks of gestation has also been reported [38,39]. The main advantage of the laparoscopic approach is the complete removal of the retained products of conception at the time of the surgery leading to a less prolonged follow-up [13].…”

Section: Discussionmentioning

confidence: 99%

Caesarean Scar Pregnancy: A Case Report and a Literature Review

Valasoulis

Magaliou²,

Koufidis³

et al. 2022

Medicina

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Background and Objectives: Caesarean scar pregnancy (CSP) refers to placental implantation on or in the scar of a previous caesarean section and represents a potentially life-threatening condition. CSP is considered a diagnostic challenge in obstetrics, with the diagnosis relying mainly on transvaginal ultrasound (TVS) and the management depending upon case presentation and available healthcare infrastructures. Case Presentation: We present a case of 34-year-old G3P2 with a history of two-previous caesarean sections referred to the outpatient gynaecology clinic of our Department at the 7th week (7/40) of gestation with abnormal early pregnancy TVS findings, illustrating the gestational sac attached to the caesarean scar and a foetal pole with evidence of foetal cardiac activity. We discuss the outcome of an alternative combined medical and surgical approach we followed as well as an updated review of the current literature. Conclusions: The ideal management of CSP requires tertiary centers, equipment availability and experienced healthcare professionals capable of dealing with any possible complication, as well as individualized treatment based on each case presentation.

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Section: Discussionmentioning

confidence: 99%

Caesarean Scar Pregnancy: A Case Report and a Literature Review

Valasoulis

Magaliou²,

Koufidis³

et al. 2022

Medicina

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“…In some selected cases of CSP, the surgical option may be considered [ 1 , 7 , 16 , 17 ]: Uterine curettage: Some authors [ 18 ] proposed performing aspiration curettage as the first therapeutic option in patients with superficial implantation who meet all the following diagnostic criteria: <8 weeks' gestation; a myometrial thickness between the bladder and gestational sac of >2 mm; and hemodynamic stability. In the case of suction curettage, it should be performed guided by transabdominal ultrasound, with a small cannula (4 or 6) and with a maximum suction pressure of 300 mmHg.…”

Section: Discussionmentioning

confidence: 99%

“…It can be performed simultaneously with the help of a Foley balloon [ 18 ]. Hysteroscopy: It is a therapeutic option with a low complication rate [ 19 , 20 ] that can be considered as an alternative to curettage in patients with the same criteria described for uterine curettage Surgical resection by laparoscopy or laparotomy [ 17 ]: It is an option in cases in which there is bladder infiltration [ 20 ], as well as in cases of suspected uterine rupture Hysterectomy may be indicated in cases of uncontrollable bleeding or the impossibility of conservative treatment [ 7 ]. …”

Section: Discussionmentioning

confidence: 99%

“…Surgical resection by laparoscopy or laparotomy [ 17 ]: It is an option in cases in which there is bladder infiltration [ 20 ], as well as in cases of suspected uterine rupture…”

Section: Discussionmentioning

confidence: 99%

“…Surgical Treatment. In some selected cases of CSP, the surgical option may be considered [1,7,16,17]:…”

Section: Medical Treatment Conservative Treatment With Systemicmentioning

confidence: 99%

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Conservative Management of Cesarean Scar Pregnancy: A Case Report and Literature Review

Sánchez‐Prieto

Puy

Barbany

et al. 2022

Case Reports in Obstetrics and Gynecology

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Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy located in the lower uterine segment. The current increase in the percentage of cesarean sections is accompanied by significant growth in the incidence of CSP, while advances in ultrasound diagnostic techniques have led to a greater number of CSP diagnoses. A misdiagnosed CSP, or one that is diagnosed too late, is life-threatening to the pregnant patient and predisposes her to complications such as uterine bleeding or rupture, which often require hysterectomy and thus result in the irreversible loss of fertility. We present the case of a 50-year-old woman with a history of undiagnosed CSP after multiple consultations for intermittent bleeding and hemorrhage. She was diagnosed by ultrasound and the diagnosis was confirmed by hysteroscopy. She underwent conservative medical treatment that was successful.

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Evaluation of Therapeutic Effect of Resectoscopic Surgery on 90 Cases of Cesarean Scar Pregnancy

Tanha

Saeedi²,

Ebrahimi³

et al. 2023

SN Compr. Clin. Med.

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Introduction: Although the prevalence of cesarean scar pregnancy (CSP) is rare, its complications can be life threatening.It seems there is a force need for a treatment that has the minimum chance of massive blood loss and injury to the uterus with fertility preservation in these cases. Hence, the current study aimed to evaluate the safety and e cacy of resectoscopic surgery treatment in cesarean scar pregnancy.Methods: This single-arm interventional study was conducted on 90 patients with the diagnosis of CSP at a tertiary university-based hospital from April 2019 to 2021.Results: The mean age of patients was 30.90±6.05 years with ranges of 18 to 45. The average gestational age at diagnosis time was 7.27±2.06 weeks and baseline myometrial thickness mean was 1.46±0.56 mm. In near half of the cases, the baseline β-hCG was lower than 10000 IU/ml. About 48 hours after study intervention, the β-hCG mean level decreased signi cantly (p-value=0.009), 34965.97±104670.23 to 6264.12±8622.93 IU/ml. For all patients except two, at least a 30% decline in baseline β-hCG was reached, and in most cases, this decrease was more than 50%. Although the Hb mean level decreased signi cantly (p-value<0.001) after study intervention, 12.87±1.63 to 11.27±1.88 g/dL, this decline was lower than 50% in all study patients, and in half of cases it was less than 10%.Conclusion: It seems resectoscopy, in patients with CSP, can rapidly reduce serum β-hCG concentration without any signi cant blood loss or organ injury, as well as decline hospital stay length; hence, it may be suggested as a safe, nonexpensive strategy in CSP management.

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A laparoscopic approach to cesarean scar ectopic pregnancy

Cited by 8 publications

References 7 publications

Caesarean Scar Pregnancy: A Case Report and a Literature Review

Caesarean Scar Pregnancy: A Case Report and a Literature Review

Conservative Management of Cesarean Scar Pregnancy: A Case Report and Literature Review

Evaluation of Therapeutic Effect of Resectoscopic Surgery on 90 Cases of Cesarean Scar Pregnancy

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