Laparoscopic Management of Cesarean Scar Pregnancy

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<h3>Study Objective</h3> To present a case and surgical video of a laparoscopic excision of a cesarean scar pregnancy at 12 weeks and review the literature regarding cesarean scar pregnancy management. <h3>Design</h3> Case report and surgical video. <h3>Setting</h3> Tertiary care hospital. <h3>Patients or Participants</h3> One patient. <h3>Interventions</h3> 23 y/o G5P0131 at 7 weeks 1 day with history of obesity and a 31-week low transverse cesarean delivery presented for initial prenatal care to an outside OB. Cesarean scar pregnancy diagnosis was not recognized until patient presented for a nucal translucency to maternal fetal medicine at 11 weeks and 3 days where suspicion for scar pregnancy was raised. Patient was referred to our institution where cesarean scar pregnancy was confirmed at 11 weeks and 6 days and laparoscopic excision was recommended, as it was felt that pregnancy was too large and advanced in gestational age for medical management to be successful. Patient underwent uterine artery embolization and fetal intra-cardiac KCl injection the day prior to procedure to prevent hemorrhage during surgery, then patient underwent laparoscopic excision of cesarean scar pregnancy. <h3>Measurements and Main Results</h3> Laparoscopic excision of cesarean scar pregnancy was completed successfully with no intra or post-operative complications. Surgical techniques are reviewed in the surgical video. Patient had a good surgical recovery. <h3>Conclusion</h3> Laparoscopic excision of a cesarean scar pregnancy can be accomplished successfully with good outcomes when preventative measures to achieve good hemostasis such as pre-operative uterine artery embolization and fetal intra-cardiac KCl injection are used.