Laparoscopic management of cervical-isthmic pregnancy: a proposal method

Objective: To describe a rare case of a singleton 9-week cervical-isthmic pregnancy (CIP), treated by laparoscopic removal of the ectopic pregnancy and suturing of the uterine site of the ectopic pregnancy with single stitches. Design: Case report. Setting: Main general hospital. Patient(s): A 37-year-old woman was admitted for suspected singleton CIP at week 9, following two Cesarean sections. Clinical examination, beta-hCG increase, and transvaginal ultrasonography were used to monitor the suspected diagnosis of an ectopic pregnancy. Following failure of methotrexate administration, surgeons performed a laparoscopy. Intervention(s): The CIP removal was performed by laparoscopic incision, enucleating the isthmic mass and suturing the uterine site of the ectopic pregnancy with single stitches. Main Outcome Measure(s): Intraprocedural or postprocedural complications and uterine integrity preservation. Result(s): Postoperative recovery period was normal, without intraprocedural or postprocedural complications. Uterine integrity was preserved. No further therapeutic interventions were needed in follow-up. Conclusion(s): In the case of CIP in women interested in minimally invasive treatment, resection of an ectopic pregnancy and suturing of the removal site may be an option to preserve uterine integrity. By improving endosurgical skills, these treatments may be safely proposed avoiding further invasive therapies. (Fertil Steril (R) 2009;92:829.e3-e6. (c) 2009 by American Society for Reproductive Medicine.)