Work

Single-incision laparoscopic surgery of cesarean scar ectopic pregnancy: a case report and review of literature

Year: 2018

Type: article

Abstract: Background:Cesarean scar ectopic pregnancy (CSEP) is the rarest location for ectopic pregnancy; with implantation within the cesarean scar defect (CSD) of the uterus. The primary pathology stems from wound poor healing, resulting in focal thinning of the uterine scar; predisposing the site for gestational sac implantation. Current CSP treatment approaches include methotrexate (MTX), bilateral uterine artery embolization, dilation and curettage (D&C) and open or laparoscopic surgical repair. We report a case of CSEP diagnosed via ultrasound and managed with methotrexate, dilatation and curettage (D&C) with single-incision laparoscopic surgery (SILS) resection of the CSEP. Case: 38-year-old Gravida 4, Para 3003 at 7-4/7weeks presents with intermittent bleeding and passage of clots. Bedside transvaginal ultrasound showed CSEP with detectable fetal heart tones.B-hCG value was >30,000mIU/mL. Obstetrics history included a normal spontaneous vaginal delivery followed by two cesarean deliveries. For this case the patient opted for diagnostic hysteroscopy, suction D&C, with SILS robotic resection of the CSEP, and umbilical hernia repair. The patient had an unremarkable recovery course and was discharged from the hospital on postoperative day 1, with plan to follow-up weekly for quantitative B-hCG levels. Conclusion:CSEP presents challenges for clinicians as there is conflicting data on the best mode of treatment. Our case presents a SILS surgical approach in combination with hysteroscopy for improved visualization. The authors have found this technique to be effective, but through review of the literature endorse the 3D-MESIA protocol alternative.

Source: Obstetrics & Gynecology International Journal

DOI: 10.15406/ogij.2018.09.00327