EP29.07: Hysteroscopic management of Caesarean section scar and interstitial (cornual) pregnancy

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There is no consensus about surgical approach in cases of Caesarean section scar (CSSP) and interstitial (cornual) pregnancy (ISP). The optimal management is yet to be defined because it represents a rare form of ectopic pregnancy. With the raising number of Caesarean section deliveries the rate of this type of ectopic pregnancy increases. The raising trend in minimally invasive surgery offers new treatment modalities. We present two cases of ectopic pregnancies successfully managed by minimally invasive surgical technique: hysteroscopic resectoscope removal of retained products of conception (RPOC). Case 1: a 42-year-old Caucasian woman, gravida 2, Caesarean section 2, at 7 weeks gestation was diagnosed with pregnancy in the scar of previous Caesarean section - niche, with 2 hybrid myomas on the anterior wall of uterus measured in diameter 90x76 mm and 41x39 mm. Transvaginal ultrasound (TVUS) examination revealed endogenic type I CSSP. The initial beta human chorionic gonadotropin (b-hCG) was 93.745 IU/L. After one 50 mg dose methotrexate, she underwent hysteroscopic-guided removal (HGR) of embryo, leaving chorionic sac in situ. After 3 months, b-hCG fell to 158 IU/L, and vacuum aspiration of chorionic sac was performed. The intervention was successful, without complication. Case 2: a 29-year-old Caucasian woman, gravida 0, at 9 weeks gestation, with ectopic interstitial pregnancy in left cornu. Initial b-hCG on admission valued 1.666 IU/L. After laparoscopic confirmation of the interstitial pregnancy, the patient underwent HGR of the ISP. We used hysteroscopic resectoscope (HR) as a tool. Successful minimally invasive treatment using HR in both ectopic CSSP and ISP may be applied. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.