Hysteroscopic management of cesarean scar ectopic pregnancy

Objective: To present our experience with hysteroscopic removal of cesarean scar ectopic pregnancy (CSP) and review the literature on the current management. Design: Retrospective cohort study. Setting: A tertiary referral university hospital, Sydney, Australia. Patient(s): Six patients diagnosed with CSP. Intervention(s): Four patients were successfully treated with primary hysteroscopic removal of the ectopic pregnancy. Two patients were treated with systemic methotrexate (MTX), which failed; one patient had a subsequent hysteroscopic removal of CSP, and the second had local injection of MTX to the gestational sac. Main Outcome Measure(s): Clinical, serological, and ultrasound data and follow-up for subsequent pregnancies. Result(s): For the women treated surgically, the median time for the return of beta hCG to <5 mIU/mL was 30 days, the mean operative time was 35 minutes, and the mean estimated blood loss was 140 mL. Three pregnancies were achieved: a miscarriage, a term pregnancy that resulted in a live birth, and an ongoing intrauterine pregnancy. The patient who was managed by MTX took 105 days for the beta hCG to normalize and had an ongoing hematoma at the site of the CSP that took 247 days to resolve. Conclusion(s): Hysteroscopic management of CSP offers advantages over local injection with MTX and systemic MTX with a more rapid return to normal beta hCG level and reduction in follow-up time. (Fertil Steril(R) 2010;93:1735 (C) 2010 by American Society for Reproductive Medicine.)