Treatment Options To Terminate Persistent Cesarean Scar Pregnancy

Abstract

Aims: Persistent Cesarean scar pregnancy (PCSP) is a rare and special type of Cesarean scar pregnancy (CSP) which is resistant to conservative treatment. The treatment option is challenging. We report a case series to provide indications for further treatment. Methods: Ten women diagnosed as having a PCSP, seeking better treatment because of primary treatment failure, were admitted to a gynecologic minimally invasive center. Ultrasound combined with office hysteroscopy was used for preoperative evaluation, and then a further surgical strategy was selected. Clinical data were retrospectively studied. Results: Among ten PCSP patients, 4 were type I and 6 were type II. In the 4 type I cases, 2 were treated by laparoscopy and the other 2 by hysteroscopy; to stop bleeding in 1 of them, the uterine artery was occluded laparoscopically. All type II cases were successfully treated by laparoscopic excision. The mean operating time was 61.5 min. The mean blood loss was 83.5 ml. No complications occurred except one intraoperative hemorrage. Conclusions: Experience from this case series indicates that an individualized surgical plan based on a full preoperative evaluation provides useful information for choosing a suitable treatment for PCSP. Endoscopically guided surgical excision with experienced hands may be considered the most useful treatment.

Risk Factors for Haemorrhage during Suction Curettage after Uterine Artery Embolization for Treating Caesarean Scar Pregnancy: A Case-Control Study

“…Conventional laparotomy can remove the CSP completely, but leads to a larger surgical wound and longer hospital stay. Moreover, hysteroscopic or laparoscopic surgery requires general anaesthesia, operative skill and specialist facilities [5,18]. …”

Beyond Guidelines: Effectiveness of a Programme in Achieving Operative Laparoscopy for all Women Requiring Surgical Management of Ectopic Pregnancy

“…This is evidenced by laparoscopic treatment of the series of extratubal pregnancies such as Caesarean scar and abdominal pregnancies. Laparoscopic treatments of such complex presentations have usually been achieved in units set up with considerable laparoscopic skills and facilities [31,32]. …”

Exploration of the Successful Treatment Algorithms Used in 23 Cases of Early Live Cesarean Scar Pregnancy

“…Pregnancy lesion resection through open surgery + uterine repair aggravates patients' trauma, prolongs their hospital stay, and increases their economic burden. Hysteroscopy followed by curettage [14] and hysteroscopy alone or combined with uterine artery embolization [17] are likely to cause hemorrhea due to contact of the lens with the gestational sac. The conversion to other measures will miss the best opportunity to empty the uterine cavity and lessen bleeding.…”

“…Due to the rich blood supply in live CSP, touching the lesion with the endoscope inevitably leads to hemorrhage, so prior hysteroscopy [14] is not suggested. For the 23 patients, preparations for blood transfusion, infusion, operation, and resuscitation were performed before the procedure.…”