OP35.01: Transrectal ultrasound guided surgical evacuation of Cesarean scar ectopic pregnancy

Abstract

We aimed to describe a new technique for the management of Cesarean scar ectopic pregnancy (CSEP): transrectal ultrasound guided surgical evacuation. 1,395 consecutive pregnant women who presented to the Early Pregnancy Unit (EPU) in the study period underwent a transvaginal ultrasound (TVS). CSEP was diagnosed if all the following criteria were met: absence of an intra-uterine pregnancy; empty endocervical canal; presence of a gestational sac implanted within the lower anterior segment of the uterine corpus, with or without evidence of myometrial thinning. Women were offered transrectal ultrasound-guided surgical evacuation under general anaesthesia. Successful treatment was defined as complete primary evacuation of CSEP. The need to perform additional interventions (emergency cervical cerclage, insertion of Foley's balloon catheter, blood transfusions) was recorded. 7 out of 1395 (0.50%) women who presented to the EPU were diagnosed with CSEP. 3/7 (43%) were viable at the time of diagnosis. 2/7 (29%) followed IVF; 6/7 (86%) women had a single Cesarean section. One woman had a previous tubal ectopic pregnancy, and one a previous CSEP. 3/7 (43%) women were asymptomatic. 6/7 (86%) women were treated with transrectal ultrasound-guided surgical evacuation as the primary treatment, whilst 1/7 (14%) was given systemic MTX. No major complications were observed. In our hands, transrectal ultrasound-guided surgical evacuation has proven to be an alternative treatment for CSEP, however a larger sample and further study may be needed.