Endoscopic management of cesarean scar pregnancy

Objective: To describe our experiences with the diagnosis and endoscopic treatment of cesarean scar pregnancy. Design: Prospective clinical study. Setting: Tertiary care university hospital. Patient(s): Eleven women treated in our division between 1999 and 2004 who had been diagnosed with cesarean scar pregnancy. Intervention(s): Transvaginal ultrasound was used for diagnosis, and endoscopy (laparoscopy and/or hysteroscopy) was used to treat cesarean scar pregnancy and preserve fertility. Main Outcome Measure(s): Operative blood loss, hospital stay, and time to resolution of serum beta hCG were recorded. Result(s): The gestational age at diagnosis ranged between 6 and 11 weeks. Laparoscopic treatment was used in four women, hysteroscopic treatment in six women, and one woman underwent combined treatment with laparoscopy and hysteroscopy. The average blood loss during surgery was 110.9 mL (range, 20-300 mL), and average hospital stay was 1.7 days (range, 0.25-3 days). No complications occurred, and no blood transfusion was required. All patients uteri were successfully preserved, and serum hCG levels declined to a normal limit within 4 weeks postoperatively. Conclusion(s): When the diagnosis of cesarean scar pregnancy is made in the first trimester, endoscopy can be an alternative surgical treatment; the prognosis is good, and fertility can be preserved.