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Nov 17, 2019

The 27th World Congress on Controversies in Obstetrics, Gynecology & Infertility

HYSTEROSCOPIC MANAGEMENT OF CESAREAN SCAR ECTOPIC PREGNANCY: A CASE REPORT

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Caesarean scar pregnancy

hysteroscopic surgery

ectopic pregnancy

Abstract

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Abstract

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Keywords

Caesarean scar pregnancy

hysteroscopic surgery

ectopic pregnancy

Abstract

Problem statement: Caesarean scar pregnancy (CSP) is a rare iatrogenic entity, affecting 1/2000 pregnancies. It represents about 6% of ectopic pregnancies in women with a previous caesarean section. This situation must be distinguished from a spontaneous abortion in progress or a cervical pregnancy. The management of CSP is an unexplored clinical field and a standard protocol is still missing. The hysteroscopic removal of CSP is an option. Methods Retrospective case report. In this case report, we describe a woman with CSP diagnosed by transvaginal ultrasound who was initially treated as spontaneous abortion in progress with vaginal misoprostol and underwent a hysteroscopic surgery after medical treatment failure. Results A 41-year-old woman, gravida 5, with a past history of one cesarean section. She went to the emergency department of Hospital Senhora da Oliveira 10 days after she has been treated in another institution for spontaneous abortion in progress, with vaginal misoprostol. She reported amenorrhea for eight weeks and had a normal clinical exam, with only small vaginal bleeding. Transvaginal ultrasound showed an enlarged uterus, and a hypoechoic structure at the isthmus overlying the caesarean scar, compatible with a gestational sac, which presented yolk sac and an embryo with cardiac activity. The adnexa were normal. Hysteroscopic surgery was decided. The operative finding revealed a gestational sac in a cesarean scar defect. The resection was performed using hysteroscopic scissors and grasping forceps. The gestational tissue was cut and it was completely removed. The cesarean scar defect was inspected to ensure that there were no remaining tissue. No perforation or other complications occurred during the operation. The postoperative period was uneventful and she was discharged on the 2nd day after the surgery. Her serum β-hCG level was 169 mIU/mL 4 weeks later. Conclusion An early and prompt diagnosis of CSP is essential. Hysteroscopic removal of CSP provides good prognosis and should be an option for CSP management.

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© Copyright 2019 Morressier GmbH.
All rights reserved.