Laparoscopic Excision of Cesarean Scar Ectopic Pregnancy
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INSTRUMENTATION AND TECHNIQUES
Laparoscopic Excision of Cesarean Scar Ectopic Pregnancy Kusum Lata1 · Amenda Ann Davis2 · Akshita Panwar2 · Isha Kriplani1 · Seema Sharma2 · Alka Kriplani2
© Federation of Obstetric & Gynecological Societies of India 2020
Abstract Background Cesarean scar ectopic pregnancies are increasing in frequency, due to rise in cesarean deliveries. They should be managed early in pregnancy, preferably by surgical excision, failing which they may rupture, or later develop into morbidly adherent placenta. Methods This is a series of five cases described to explain the instrumentations and techniques in the laparoscopic excision of cesarean scar ectopic pregnancies. Written consent was taken from the patients. Results All five patients underwent successful laparoscopic excision. Follow-up period was uneventful. Conclusion Laparoscopic excision of cesarean scar ectopic is a technically demanding procedure, but with excellent results. All gynecologists should be familiar with this technique due to the increasing incidence of cesarean scar ectopic gestations. Keywords Cesarean scar ectopic · Laparoscopic excision · Isthmocoele repair
Introduction Cesarean scar ectopic pregnancies are becoming increasingly common, mirroring the rise in overall cesarean deliveries [1]. They account for one in 500 pregnancies in women with previous cesarean delivery, and 4% of all ectopic pregnancies [2]. There is a myriad of options to manage such pregnancies, and there is no consensus regarding the best modality of treatment, which includes expectant management, medical management with methotrexate, and surgical techniques. Laparoscopic, vaginal, and open excision and repair of the defect are associated with a 96% success rate [2]. We present a series of five cases of cesarean scar ectopic which were managed by laparoscopic scar excision Dr. Kusum Lata is an assistant professor at the All India Institute of Medical Sciences, Delhi. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s13224-020-01325-5) contains supplementary material, which is available to authorized users. * Amenda Ann Davis [email protected] 1
Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
Department of Obstetrics, Gynaecology, and ART, Paras Hospitals, Gurgaon, India
2
and repair. Written consent has been taken from all of the patients.
Case 1 Mrs. A was an asymptomatic 39-year-old fourth gravida at 6 weeks 1-day of gestation, with history of two cesarean deliveries and a curettage following a missed abortion. An early pregnancy ultrasound was suggestive of pregnancy in the cesarean scar. A three-port laparoscopy was performed, which confirmed scar ectopic pregnancy. The uterus was approximately of 8 weeks size, with a 3 × 3 cm hyper-vascular gestational sac protruding through and adherent to the previous scar. The urinary bladder was pushed down, the retroperitoneum was opened, and bilateral uterine arteries were clipped.
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