Hysteroscopy and suction evacuation of cesarean scar pregnancies: A case report and review

Abstract

Implantation of a pregnancy into the scar of a prior cesarean is an uncommon type of ectopic pregnancy. The incidence of cesarean scar pregnancy is thought to be one in 1800-2216 pregnancies. The increase in the incidence of cesarean scar pregnancy is thought to be a consequence of the increasing rates of cesarean delivery. The natural history of cesarean scar pregnancy is unknown. However, if such a pregnancy is allowed to continue, uterine scar rupture with hemorrhage and possible hysterectomy seem likely. Two early diagnosed cesarean scar pregnancies were treated with hysteroscopy and suction curettage removal. One required intramuscular methotrexate to resolve a persistent cesarean scar ectopic pregnancy. It would seem reasonable that simple suction evacuation would frequently leave chorionic villi imbedded within the cesarean scar, as the pregnancy is not within the endometrial cavity.

Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review

“…Regardless of the chosen treatment modality, serum β-hCG should be followed to zero, as persistent trophoblastic tissue may occur after any medical or surgical treatments except hysterectomy [9, 186]. In patients undergoing upfront surgical management, D&C alone is often complicated by hemorrhage.…”

“…Hysteroscopic resection of cesarean scar EPs has been performed successfully and without complication using biopolar or ‘electric’ loops, in patients with serum β-hCG up to 28,333 mIU/mL [186, 189, 190]. Hysteroscopic resection is not recommended when the residual myometrium is less than 3 mm, given the risk of anterior wall perforation and bladder injury [191, 192].…”

Conventional laparotomy for management of caesarean scar ectopic pregnancy: a case report

“…[9][10][11] Apart from a slight reduction in blood loss, systemic methotrexate, methotrexate uterine artery injection/ embolisation and excision by laparotomy have been found to be comparable.…”

Ectopic Mural Pregnancy

“…[75,[82][83][84][85][86]. В тоже время, системное и местное при-менение лекарственной терапии рассматривается как безопасное и эффективное лечение CSP [1].…”

“…MTX -наиболее широко используемый препарат (самостоятельно, либо в комбинации с фолиевой кислотой). Несмотря на выбранный метод лече-ния, сывороточный уровень ХГЧ должен снизить-ся до нуля, между тем как персистирующие массы трофобласта могут обнаруживаться как после ме-дикаментозного, так и после хирургического лече-ния, исключая гистерэктомию [70,82].…”