Hemodynamically Unstable Cesarean Ectopic Pregnancy

Abstract

Video Objective To review cesarean ectopic pregnancy and evaluation of patient hemodynamic status by calculating estimated blood loss (EBL), class of hemorrhagic shock, and shock index (SI). This is a case example of conservative surgical treatment for cesarean scar ectopic pregnancy in the face of hemodynamic instability. Setting Mount Sinai Hospital and Medical Center in Chicago, Illinois. Interventions A 33 year old G4P2103 at 6w2d with history of one prior cesarean section was transferred to our institution from a tertiary care center for findings consistent with cesarean ectopic pregnancy. The patient was in class II hemorrhagic shock, with EBL of 1.4L and a SI of 1.03, warranting immediate surgical management. Diagnostic laparoscopy showed a 3cm cesarean ectopic pregnancy in the lower uterine segment (LUS) near the isthmic region. Uterine arteries were ligated bilaterally to minimize blood loss. The gestational sac was carefully excised from the LUS and the isthmocele was repaired using a double layer closure with imbrication. Intraoperative EBL was 35mL and 2U of PRBCs were transfused during the procedure. Conclusion Cesarean ectopic pregnancy is uncommon and carries risk of massive hemorrhage, therefore timely assessment of hemodynamic status is vital in guiding management. Our patient was promptly evaluated and successfully treated for a hemodynamically unstable type 1 cesarean scar pregnancy by laparoscopic cesarean ectopic resection and isthmocele repair.