Management of Cesarean Scar Pregnancy Via Laparoscopic and Transcervical Approaches

Abstract

<h3>Study Objective</h3> To detail novel management of sequelae of pre-operative uterine artery embolization in the setting of a cesarean scar pregnancy in a patient undergoing laparoscopic uterine wedge resection. <h3>Design</h3> A video case report with follow up at 2- and 6-weeks post-procedure. <h3>Setting</h3> An operative suite at a tertiary care center. <h3>Patients or Participants</h3> A 30-year-old woman with cesarean scar pregnancy in the setting of one prior cesarean section who underwent uterine artery embolization. Following embolization, she developed significant clot in the uterus, consistent with placental abruption, which was unable to be evacuated with uterine wedge resection alone. <h3>Interventions</h3> Uterine artery embolization followed by laparoscopic uterine wedge resection of a cesarean scar pregnancy with hysteroscopy and dilation and aspiration under direct laparoscopic visualization. <h3>Measurements and Main Results</h3> Approximately 100cc of additional products of conception and clot was evacuated from this patient by using a secondary method of uterine evacuation (dilation and aspiration). <h3>Conclusion</h3> Use of both laparoscopic and transcervical resection of cesarean scar ectopic pregnancy resulted in increased evacuation of products of conception. Further study is warranted to determine if this results in overall decreased blood loss in patients.