Abstract
To propose a novel procedure as a safe and effective treatment for cesarean scar pregnancy (CSP), a cohort study was initiated in patients diagnosed with CSP and treated with transvaginal hysterotomy from December 2009 to March 2013, either as a primary or secondary therapy. All diagnoses were confirmed by both sonography and pathology, either a gestational sac or residual tissue after termination of pregnancy or miscarriage in the cesarean section scar. Basic clinical characteristics and perioperative data were collected and analyzed. A total of 40 patients were included. The mean age was 32.88 ± 4.55 years. The mean size of gestational sacs of the CSP mass at diagnosis was 33.78 ± 13.14 mm. Mean serum β-hCG level at diagnosis was 47379.73 ± 45285.10 IU/L. Mean operative time was 57.25 ± 24.52 min. Mean postoperative hemoglobin drop was 1.635 ± 0.906 g/dL. Complications were one case of bacteremia and two cases of hematoma. Mean hospital stay after surgery was 4.95 ± 2.62 days. Mean serum β-hCG levels decreased by 88.5, 93.5, and 96.5 % at postoperative day 2, 4, and 6, respectively. All patients’ β-hCG levels returned to normal range within 1 month after surgery. Transvaginal hysterotomy with removal of ectopic pregnancy tissue and repair of cesarean scar defect is a promising approach to manage CSPs, with a short hospital stay, low postoperative pain, blood loss, and cost.Electronic supplementary materialThe online version of this article (doi:10.1007/s10397-014-0863-3) contains supplementary material, which is available to authorized users.
Highlights
As a rare form of ectopic pregnancy, cesarean scar pregnancy (CSP) refers to the implantation of a pregnancy within the myometrium at the site of a prior cesarean scar
Cesarean scar pregnancy was diagnosed by ultrasonography and β-human chorionic gonadotropin (β-hCG) level
These were patients in whom the diagnosis was made based on prolonged vaginal bleeding, elevated β-hCG level, and a heterogeneous mass at the same site as the gestational sac described above
Summary
As a rare form of ectopic pregnancy, cesarean scar pregnancy (CSP) refers to the implantation of a pregnancy within the myometrium at the site of a prior cesarean scar. If not detected early and managed properly, CSP can result in life-threatening complications, such as massive hemorrhage, uterine rupture, disseminated intravascular coagulation, and even maternal death [1]. Therapy is strongly recommended to avoid subsequent life-threatening complications. By following the concepts of minimally invasive surgery, we designed and carried out the first case of hysterotomy by transvaginal approach for the treatment of CSP in 2009. Since 2009, we have successfully completed 40 transvaginal CSP cases without significant complications. We summarize our experience with this novel surgical approach for CSP and propose the procedure as a safe, effective, and minimally invasive treatment modality
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