8557 Laparoscopic Resection of Involuting Cesarean Scar Pregnancy after Failed Multidose Methotrexate and KCl Treatment

Abstract

<h3>Study Objective</h3> To describe the workup, treatment, and follow up of a cesarean-section scar ectopic pregnancy (CSP) that failed medical management and to demonstrate a laparoscopic resection of a cesarean section scar ectopic pregnancy that has failed medical management. <h3>Design</h3> Surgical video. <h3>Setting</h3> An academic teaching hospital and tertiary care center. <h3>Patients or Participants</h3> 36-year-old G2P2022, with a persistent cesarean scar ectopic pregnancy, who failed medical management with a multi-dose Methotrexate protocol and intrasac KCl injection and presented 3 months later for infertility evaluation. <h3>Interventions</h3> After failing medical management, the patient consented for a laparoscopic resection of CSP with revision of the previous scar. During surgery, the patient was found to have an involuting ectopic pregnancy at the site of the previous scar, which was successfully resected. The uterine incision was repaired in two layers. <h3>Measurements and Main Results</h3> The laparoscopic repair was completed successfully. Pathology showed fibrotic and necrotic chorionic villi with an adjacent decidual reaction consistent with a pregnancy. The patient's beta-hcg trended down to non-pregnant levels and she had a normal postoperative visit with no concerns. <h3>Conclusion</h3> Recommended treatment for CSP includes surgical resection, as medical management alone is unlikely to be successful. Key strategies for laparoscopic excision include use of backfilling the bladder to delineate borders, avoidance of excessive thermal energy, and closure of the defect in multiple layers.