Abstract
Purpose
To explore the feasibility of surgical management of cesarean scar ectopic pregnancy (CSEP) using a transvaginal approach.
Methods
Thirty-eight patients with CSEP presenting at the Shenzhen Nanshan People’s hospital between January 2008 and May 2012 were reviewed in the study. Ten patients underwent uterine artery embolization, 13 patients underwent endoscopic CSEP removal in combination with chemotherapy and 15 received transvaginal surgical therapy (transvaginal group). Patients were followed up for between 3 and 48 months.
Results
Postoperative fever and irregular menstrual bleeding after healing were each observed in one of ten patients undergoing embolization. No pregnancies were reported in this group during follow-up. Endoscopy procedures included two patients undergoing laparoscopy and 11 undergoing hysteroscopy resection. There were six pregnancies during follow-up in this group. Transvaginal surgery was performed uneventfully in all cases. All patients recovered without complications. There were no reports of irregular menstrual bleeding or changes in menstrual blood volume. Serum HCG levels declined rapidly to within the normal range. The time to menstrual cycle recovery (29.2 ± 5.7 days) was significantly shorter than with endoscopic surgery (37.6 ± 8.2 days) or embolization (64.4 ± 9.2 days; P < 0.05). Three patients became pregnant after transvaginal surgery.
Conclusion
Transvaginal removal of ectopic pregnancy tissue is a new surgical approach for the treatment of CSEP. The efficacy and safety of the approach needs further confirmation.
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References
Tinelli A, Tinelli R, Malvasi A (2009) Laparoscopic management of cervical-isthmic pregnancy: a proposal method. Fertil Steril 92:823–826
Deans R, Abbott J (2010) Hysteroscopic management of cesarean scar ectopic pregnancy. Fertil Steril 93:1735–1740
Rotas MA, Haberman S, Levgur M (2006) Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol 107:1373–1381
Maymon R, Halperin R, Mendlovic S, Schneider D, Vaknin Z, Herman A, Pansky M (2004) Ectopic pregnancies in Caesarean section scars: the 8 year experience of one medical centre. Hum Reprod 19:278–284
Somoye G, Rose D, Hoveyda F (2008) Management of embedded products of conception in a previous caesarean scar by hysteroscopy and curettage. J Obstet Gynaecol 28:111–112
Hsieh BC, Hwang JL, Pan HS, Huang SC, Chen CY, Chen PH (2004) Heterotopic Caesarean scar pregnancy combined with intrauterine pregnancy successfully treated with embryo aspiration for selective embryo reduction: case report. Hum Reprod 19:285–287
Robinson JK, Dayal MB, Gindoff P, Frankfurter D (2009) A novel surgical treatment for cesarean scar pregnancy: laparoscopically assisted operative hysteroscopy. Fertil Steril 92(1497):e1413–e1496
Chen CH, Wang PH, Liu WM (2009) Successful treatment of cesarean scar pregnancy using laparoscopically assisted local injection of etoposide with transvaginal ultrasound guidance. Fertil Steril 92:1747.e9–e11
Wang YL, Su TH, Chen HS (2005) Laparoscopic management of an ectopic pregnancy in a lower segment cesarean section scar: a review and case report. J Minim Invasive Gynecol 12:73–79
Fylstra DL (2002) Ectopic pregnancy within a cesarean scar: a review. Obstet Gynecol Surv 57:537–543
Michener C, Dickinson JE (2009) Caesarean scar ectopic pregnancy: a single centre case series. Aust N Z J Obstet Gynaecol 49(5):451–455
Ash A, Smith A, Maxwell D (2007) Caesarean scar pregnancy. BJOG 114(3):253–263
Godin PA, Baassil S, Donnez J (1997) An ectopic pregnancy developing in a previous caesarian section sca. Fertil Steril 67(2):398–400
Maymon R, Halperin R, Mendlovic S, Schneider D, Herman A (2004) Ectopic pregnancies in a Caesarean scar: review of the medical approach to an iatrogenic complication. Hum Reprod Update 10(6):515–523
Sadeghi H, Rutherford T, Rackow BW, Campbell KH, Duzyj CM, Guess MK, Kodaman PH, Norwitz ER (2010) Cesarean scar ectopic pregnancy: case series and review of the literature. Am J Perinatol 27:111–120
Chiang AJ, La V, Chou CP, Wang PH, Yu KJ (2011) Ectopic pregnancy in a cesarean section scar. Fertil Steril 95:2388–2389
Litwicka K, Greco E (2011) Caesarean scar pregnancy: a review of management options. Curr Opin Obstet Gynecol 23:415–421
Stevens EE, Ogburn P (2011) Cesarean scar ectopic pregnancy: a case report of failed combination local and systemic methotrexate management requiring surgical intervention. J Reprod Med 56:356–358
Takeda A, Koyama K, Imoto S, Mori M, Nakano T, Nakamura H (2010) Diagnostic multimodal imaging and therapeutic transcatheter arterial chemoembolization for conservative management of hemorrhagic cesarean scar pregnancy. Eur J Obstet Gynecol Reprod Biol 152:152–156
Kang SY, Park BJ, Kim YW, Ro DY (2011) Surgical management of cesarean scar ectopic pregnancy: hysterotomy by transvaginal approach. Fertil Steril 96:e25–e28
He M, Chen MH, Xie HZ, Yao SZ, Zhu B, Feng LP, Wu YP (2011) Transvaginal removal of ectopic pregnancy tissue and repair of uterine defect for caesarean scar pregnancy. BJOG 118:1136–1139
Acknowledgments
This work is supported by Ultrasound and MRI departments. We appreciate the valuable comments from other members of our hospital.
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The authors declare that they have no conflict of interest.
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Le, A., Shan, L., Xiao, T. et al. Transvaginal surgical treatment of cesarean scar ectopic pregnancy. Arch Gynecol Obstet 287, 791–796 (2013). https://doi.org/10.1007/s00404-012-2617-7
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DOI: https://doi.org/10.1007/s00404-012-2617-7