Vaginal Approach to Cesarean Section Scar Pregnancies: A Standardized 10-step Surgical Procedure

Abstract

To show a 10-step standardized vaginal surgical technique to treat first trimester C-Section scar pregnancies. Video Article with a stepwise demonstration captured in an Operation Room of a tertiary medical center of a Low-Income country (Bolivia). C-Section scar pregnancies have a wide variety of management options. We present a vaginal surgical approach which has been developed by our group with no observed complications in 6 consecutive cases at the time of this publication. Ten-Step technique: 1.- Patient positioning, 2.- Cervical exposure and traction, 3.- Cervical infiltration with vasoconstrictor solution. 4.- Anterior mucosal incision and dissection of vesicovaginal space, 5.- Identification of vascular pedicle and ligation, 6.- Cold-Knife isthmocele incision and ectopic pregnancy evacuation, 7.- Uterine cavity curettage, 8.- Hysterorraphy with interrupted suture, 9.- Cystoscopy, 10.- Vaginal mucosa closure with running suture. We have used this technique in 6 consecutive patients. Operating time ranged between 20 - 25 minutes. All patients were discharged in postoperative day 1. We prefer surgical options for these patients since it provides both a complete removal of the ectopic pregnancy and repair of the isthmocele. A vaginal approach to such cases has proven to be a safe, simple and fully reproductible technique. We find it applicable for any patient with this pathology but especially suitable for low resource or somehow financially challenged hospitals.