Laparoscopic management of a 13 weeks viable ectopic cesarean section Scar pregnancy: a case report

Abstract

Background. Cesarean scar ectopic pregnancy is a rare type of life-threatening pregnancy whereby the embryo implants on a uterine scar, due to a previous cesarean section. It accounts for about 4.2% of total ectopic pregnancies. It is very rare that an ectopic scar pregnancy arrives undetected up to 13 weeks, but this is the case of some patients, not regularly scanned during the early pregnancy. The objective of our case report is to present a novel conservative laparoscopic approach in such cases. Case presentation. A 28-year-old G3P2A0 patient, presented to our primary care for heavy vaginal bleeding. The ultrasound performed confirmed a viable 13week embryo ectopic scar pregnancy. In this regard, the case was considered eligible for a conservative laparoscopic intervention treatment which was divided in the following steps: extensive dissection of the bladder; identification of the ectopic pregnancy at the level of the lower segment; extraction of the product of conception; suturing of the lower segment defect. Conclusions. The success of this technique may help amplifying its usage in other similar scenarios. In particular, the failure of medical treatment may be the first indication in trespassing the laparoscopic surgery approach. Further investigations about minimally invasive technologies seems undeferrable.

Cervical twin ectopic pregnancy: case report and systematic review of literature

“…No data are available on the fertility and reproductive outcome according to M a n u s c r i p t a c c e p t e d f o r p u b l i c a t i o n different managements for twin cervical pregnancies. There is no consensus on the best management in cases of ectopic pregnancies; recent evidence have shown that scar pregnancies can benefit from a laparoscopic approach [31], and also in cases of heterotopic pregnancies, the laparoscopic treatment is safe for both the woman and the in-utero pregnancy [32,33]. Data from literature showed that, in cases of tubal ectopic pregnancies, expectant management may have better reproductive outcomes compared to women who underwent surgery, with the shortest time to achieve a subsequent intrauterine clinical pregnancy [34,35].…”