Cesarean Scar Pregnancy Treated by Artery Embolization Combined with Diode Laser: A Novel Approach for a Rare Disease

Abstract

Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy which represents a consequence of a previous cesarean section. It is associated with major maternal morbidity and mortality and has potential implications on future fertility. Because of possible serious complications, CSP should be swiftly diagnosed and treated. There is no management protocol for this rare, life-threatening condition, and each patient should be evaluated individually. Several types of conservative treatment have been used to treat cesarean scar pregnancy: dilation and curettage (D&C), excision of trophoblastic tissues, local or systemic administration of methotrexate, bilateral hypogastric artery ligation, and selective uterine artery embolization with curettage and/or methotrexate administration. In our study we present a cesarean scar pregnancy of a 40-year-old woman who was treated with angiographic uterine artery embolization (UAE) followed by hysteroscopic diode laser resection. Our combined UAE–hysteroscopic laser surgery appears to offer an effective, safe, and minimally invasive surgical treatment.

Hysteroscopic Resection Followed by Adjuvant Radiotherapy: Report of a New Therapeutic Approach to Primary Cervical Diffuse Large B-Cell Lymphoma

“…We tried a hysteroscopic approach mainly for two reasons: to rapidly achieve hemostasis and to obtain a biopsy of the mass. However, during the procedure, after a partial reduction in the lesion and hemostasis that allowed a better visualization, we identified a cleavage plan that made it technically possible to remove the whole mass [ 27 , 28 ].…”

Interstitial Pregnancy Treated with Mifepristone and Methotrexate with High Serum β-hCG Level in a Patient Wishing to Preserve Fertility: Time to Define Standardized Criteria for Medical/Surgical Therapy?

“…However, the more common use of assisted reproductive technologies (ART), including ovulation induction, intrauterine insemination (IUI), in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), is leading to an increase in extrauterine pregnancy [ 9 ]. Other risk factors include previous tubal pregnancies, tubal surgeries, a history of pelvic inflammatory disease, and sexually transmitted diseases [ 1 ]. These risk factors are similar to those for other tubal pregnancies, except for ipsilateral salpingectomy, which is a risk factor specific for interstitial pregnancy.…”

“…Non-tubal ectopic pregnancy (EPs) account for fewer than 10% of all EPs [ 1 ]. Interstitial pregnancy (IP) is a rare form of ectopic pregnancy (EP) characterized by the implantation of a blastocyst in the interstitial part of the fallopian tube, which invades the myometrium [ 2 ].…”

“…Surgery is necessary in patients who are not hemodynamically stable and in case of failed medical treatment. The most effective surgical treatments are laparoscopic unilateral cornuotomy and laparoscopic unilateral salpingectomy [ 1 , 6 ]. We present the case of a woman with an interstitial pregnancy with high serum β-hCG levels (31,298 mIU/mL) who was treated with methotrexate and mifepristone to preserve her fertility.…”

The Efficacy of Transarterial Embolization for Postpartum Hemorrhage Complicated with Disseminated Intravascular Coagulation: A Single-Center Experience

“…TAE reportedly results in shorter hospital stays, requires a smaller blood transfusion volume, and may preserve fertility compared with hysterectomy [ 3 , 4 , 5 ]. Although there are valid concerns regarding the effects of TAE on women who wish to retain fertility, pregnancy after this procedure is well documented [ 6 , 7 , 8 ]. In general, pregnancy after TAE is possible without significant morbidity or mortality.…”