Abstract
Video Objective In this video, we attempted to mitigate the risk of hemorrhage during a hysteroscopic resection of a cesarean scar ectopic through temporary laparoscopic ligation of the uterine pedicles and utero-ovarian arteries. Setting The patient is a 28 y/o G4P2011 at 5 weeks gestation with history of a prior cesarean delivery who presented to the emergency department with vaginal bleeding. Transvaginal ultrasound findings showed an empty endometrial canal, however, a gestational sac and yolk sac were seen implanted within the myometrium at the lower uterine segment. These findings were consistent with a cesarean scar ectopic pregnancy, for which the patient received combined medical and surgical management. Interventions Diagnostic and operative laparoscopy were performed to obtain temporary occlusion of the uterine and utero-ovarian arteries, followed by operative hysteroscopy to resect the cesarean scar pregnancy tissue. Conclusion Temporary occlusion of the uterine and utero-ovarian arteries seems to be an effective and safe technique in reducing blood loss and should be strongly considered prior to operative management of cesarean scar pregnancies.
Published Version
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