Intact removal of spontaneous twin ectopic Caesarean scar pregnancy by office hysteroscopy: case report and literature review

Abstract

Caesarean scar pregnancy is a dangerous condition that occurs when an embryo is implanted in a previous Caesarean scar. This condition has become more frequent as a direct consequence of the increased number of Caesarean sections reported worldwide. Timely diagnosis of this condition is fundamental, and allows a conservative approach to preserving fertility. A wide range of medical and surgical strategies has been described, with no consensus on preferred management. Recently, hysteroscopic surgery has been proposed as a conservative strategy, with interesting results in reproductive outcome, postoperative course and success rate. Most cases of Caesarean scar pregnancy reported worldwide involve a singleton pregnancy. A peculiar case of fully documented office hysteroscopic removal of twin Caesarean scar pregnancy is presented in this paper. This procedure took place in a tertiary care university hospital without cervix dilatation, under conscious sedation, after failure of systemic methotrexate administration. Complete removal of the ectopic pregnancy was obtained without intra- and postoperative complications.

Cesarean scar pregnancy: A case report with surgical management after initially effective conservative treatment

“…A hysteroscopic approach is rarely used alone due to the increased need for further interventions [17]. Hysteroscopy alone may be used effectively in cases of CSPs growing inwards [18], whereas laparoscopy may be used in cases of CSPs that are growing towards the serosal uterine surface [19]. However, hemodynamic instability is a contraindication for laparoscopy and in such cases, as was in our case, a laparotomy should be performed.…”

Cesarean section scar pregnancy

“…Combined hysteroscopic and laparoscopic excision of CSSP was reported in treatment of 113 cases with a reasonably low complication rate of 18.4%, compared with other methods [18][19][20][21][22].…”

Cirugía laparoscópica e histeroscópica para embarazo ectópico sobreinfectado en cicatriz de cesárea previa: presentación de un caso

“…Otros autores reportan resultados interesantes con embarazos dobles utilizando histeroscopia de consultorio, la cual no requiere dilatación cervical y realiza bajo sedación consciente logrando la eliminación completa del embarazo ectópico (12).…”