Endoscopic Treatment of Ectopic Pregnancy in a Cesarean Scar

Study Objective: To describe our experience with endoscopic removal of cesarean scar pregnancy. Design: Retrospective study (Canadian Task Force classification II-3). Setting: Tertiary-care university hospital. Patients: Twenty-one patients with cesarean scar pregnancy. Interventions: All the patients underwent removal of pregnancy mass at hysteroscopy or combined with laparoscopy. Nine patients received a methotrexate injection before the operation, and 13 underwent uterine artery embolization before surgery. Measurements and Main Results: Clinical data, serum beta-human chorionic gonadotropin concentration, findings of ultrasound or magnetic resonance imaging examinations, therapeutic options, operative time, operative blood loss, and duration of hospitalization time were recorded. The mean serum beta-human chorionic gonadotropin concentration at diagnosis was 53 350.4 IU/ L. Seventeen patients underwent hysteroscopy, which failed in 2, and the other 4 patients underwent hysteroscopy combined with laparoscopy. Mean operative time was 51.4 minutes, and mean blood loss was estimated at 48.1 mL. A gestational mass can be removed at hysteroscopy, with rapid recovery and a high success rate. If a cesarean scar pregnancy mass grows toward the bladder and abdominal cavity, hysteroscopy combined with laparoscopy is more appropriate. Preoperative uterine artery embolization can decrease blood loss substantially during the operation. No patients underwent hysterectomy. Conclusions: Endoscopy seems to be the optimal surgical management in patients with a cesarean scar pregnancy and who desire to preserve the uterus and fertility. However, further study is warranted. Journal of Minimally Invasive Gynecology (2011) 18, 31-35 (C) 2010 AAGL. All rights reserved.