Uterine Arterial Embolization Combined with Laparoscopic Resection in the Management of Caesarean Scar Pregnancy

Abstract

Abstract

Background:

Caesarean scar pregnancy (CSP)—or isthmocele—is a rare form of ectopic pregnancy that usually is diagnosed by early pregnancy transvaginal ultrasound (TVUS) imaging.

Case:

A 33-year-old, gravida 4, para 2, alive 1, patient was diagnosed with a CSP at 7 weeks and 2 days' gestation, with TVUS signs of dense and abundant vascularization. Uterine arterial embolization (UAE) was first performed, followed by laparoscopic resection with repair of the defect, both procedures accomplished in one session of anesthesia.

Results:

This surgery was nearly bloodless and successful. The patient's human chorionic gonadotropin level became negative within 3 weeks.

Conclusions:

The natural course of CSP is a matter of controversy; however, most researchers agree with active management because of the significant risk of hemorrhage. Laparoscopic excision and repair have high success rates. Furthermore, UAE reduces the risk for hemorrhage strongly. This is the first report in the literature combining these two techniques in one general operative session. This approach could be an interesting addition to the various treatment options.