A comparison between laparoscopy and hysteroscopy approach in treatment of cesarean scar pregnancy

Abstract

The aim of the study was to compare the efficacy of laparoscopy and hysteroscopy for the treatment of cesarean scar pregnancy (CSP) and analyze the clinical factors associated with successful selection for hysteroscopic or laparoscopic treatment of CSP. We retrospectively studied 112 cases of CSP that were treated by laparoscopy and/or hysteroscopy in our hospital from December 2014 to December 2017. In total, 72 of these patients underwent ultrasound-guided curettage and hysteroscopic resection without uterine scar defect repair. Fourty of these patients underwent laparoscopic resection and repair of the uterine scar defect. We analyzed the different clinical variables between the 2 groups and identified the clinical factors which could predict the need for the laparoscopic repair of uterine scar defect. Results showed that laparoscopy and hysteroscopy were safe ways to treat CSP, and no patient underwent hysterectomy. The β-hCG level in both of the 2 groups decreased to normal 4 to 8 weeks after surgery. There were significant differences between the hysteroscopy group and laparoscopy uterine scar repair group in terms of days of amenorrhea, gestational sac diameter, myometrial thickness, operation time, intraoperative blood loss, and hospitalization duration ( P < .05). Logistic regression analysis showed that the days of amenorrhea, gestational sac diameter and myometrial thickness were independent risk factors for CSP treated by minimally invasive surgery, which were also shown by ROC curve analysis to be predictors of the need for the repair of the uterine scar defect, with optimal cutoffs of 52.50 days, 3.25 cm, and 2.05 mm, respectively; and the areas under their corresponding ROC were 0.721, 0.851, and 0.927, respectively. We conclude that laparoscopy and hysteroscopy are safe and efficient minimally invasive procedures for the treatment of CSP. The days of amenorrhea, gestational sac diameter and myometrial thickness may be key factors associated with successful selection for hysteroscopic or laparoscopic treatment of CSP.

Approaches in the Treatment of Cesarean Scar Pregnancy and Risk Factors for Intraoperative Hemorrhage: A Retrospective Study

“…Thus, all type III cases underwent LCSR in this study and achieved successful outcomes. The result here was in accordance with the past studies ( 8 , 26 ), which found that LCSR were associated with a high success rate (95.5–97.1%) and no major complications for all types of CSP. However, it may be over treatment if all the patients (including the type I and II patients) choose LCSR firstly.…”

Caesarean Scar Pregnancy: A Case Report and a Literature Review

“…Operative resection of the CSP can be performed laparoscopically, hysteroscopically or with laparotomy [33]. Suction aspiration with ultrasonographic guidance is an alternative CSP approach in the early first trimester (5 to 7 weeks), with additional use of a transcervical balloon catheter in cases where heavy bleeding takes place, as in our case [34].…”

Conservative Management of Cesarean Scar Pregnancy: A Case Report and Literature Review

“…It can be performed simultaneously with the help of a Foley balloon [ 18 ]. Hysteroscopy: It is a therapeutic option with a low complication rate [ 19 , 20 ] that can be considered as an alternative to curettage in patients with the same criteria described for uterine curettage Surgical resection by laparoscopy or laparotomy [ 17 ]: It is an option in cases in which there is bladder infiltration [ 20 ], as well as in cases of suspected uterine rupture Hysterectomy may be indicated in cases of uncontrollable bleeding or the impossibility of conservative treatment [ 7 ]. …”

“…Hysteroscopy: It is a therapeutic option with a low complication rate [ 19 , 20 ] that can be considered as an alternative to curettage in patients with the same criteria described for uterine curettage…”