Complications Associated with Cesarean Scar Ectopic Pregnancies

Abstract

Study Objective The aim of this study is to present and discuss complications that were encountered during the surgical management of cesarean scar ectopic pregnancies. Design This is a video case series of two patients with cesarean scar ectopic pregnancies. Setting Both patients were positioned in dorsal lithotomy position prior to the start of the surgeries. A primary surgeon and assistant were placed on either side of the patient. Patients or Participants Two patient case series. Patients with a diagnosis of cesarean scar ectopic pregnancy desiring laparoscopic hysterectomy were recruited. Interventions Both patients received total laparoscopic hysterectomies for the management of their cesarean scar ectopic pregnancies. Measurements and Main Results In both cases significant adhesions were noted leading to complications including uterine artery laceration, bleeding from the cesarean scar ectopic pregnancy implantation site and inadvertent cystotomy. We present in this video dissection techniques used and management of these complications. Conclusion Cesarean scar ectopic pregnancies can be difficult to managesurgically as they are often associated with significant adhesions between the anterior abdominal wall, bladder and uterus. Care should be taken to avoid inadvertent laceration of these structures when managing these cases surgically. In these surgeries, surgeons should feel comfortable with methods of laparoscopic suturing to control bleeding and repair any injuries.