CESAREAN SCAR PREGNANCY WITH PROGRESSION TO ABNORMALLY INVASIVE PLACENTA; EXPECTANT MANAGEMENT ACCORDING TO WILL OF PATIENT: REPORT OF A CASE AND LITERARY REVIEW.

Abstract

To describe temporary bilateral uterine artery occlusion with titanium clips in combination with vasopressin as an effective surgical intervention to control hemorrhage during laparoscopic management of cesarean scar pregnancies (CSPs).Retrospective study (Canadian Task Force classification III).University hospital in an obstetrics and gynecology department.Five patients with CSPs underwent removal of gestational ectopic masses via laparoscopy. At the beginning of the procedure, all 5 women had temporary bilateral uterine artery occlusion with titanium clips, and vasopressin 6 U was injected into the myometrium.Clinical data, serum β-human chorionic gonadotropin levels, operative times, and operative blood loss levels were recorded. The mean gestational age at the time of CSP diagnosis was 9.2 ± 1.9 weeks. The mean serum β-hCG level on the day of surgery was 14262 ± 12870 IU/L. The mean operative time was 86 ± 21.6 minutes, the mean uterine artery occlusion time was 58 ± 13.8 minutes, and the mean blood loss was 144 ± 79.6 mL. No cases were converted to laparotomy, no blood transfusions were required, and there were no complications.Laparoscopy combined with titanium clip occlusion of the uterine arteries bilaterally with vasopressin injection is an effective, minimally invasive procedure to preserve the uterus in patients with a CSP.