Hysteroscopic Management of Cesarian Scar Ectopic Pregnancy

Abstract

Study Objective To determine the efficacy of hysteroscopy in managing cesarian scar ectopic pregnancy. Design Case series. Setting Hysteroscopy under general anaesthesia in the dorsal lithotomy position. Patients or Participants 15 patients diagnosed with cesarian scar ectopic pregnancy with no hemodynamic instability or signs of hemoperitoneum. Interventions Hysteroscopic management of the pregnancy sac or products of conception at the site of the cesarian scar following methotrexate injection. Cold loop and electrocautery were both used to resect the entirety of the chorionic tissue. Measurements and Main Results Ultrasonography performed postoperatively to determine the efficacy of complete removal of the cesarian scar ectopic pregnancy and HCG levels serially monitored. Intra-operative blood loss measured. 14/15 patients had complete removal of the ectopic tissue in one setting, 1/15 patients required a second setting due to failure of resolution of her symptoms. None of the patients had significant blood loss in the procedure. Conclusion Hysteroscopy can be used to manage Cesarian Scar ectopic pregnancy in a minimally invasive approach.