A combination of laparoscopy and bilateral uterine artery occlusion for the treatment of type II cesarean scar pregnancy: a retrospective analysis.

OBJECTIVE: We investigated the efficacy of a combination of laparoscopy and bilateral uterine artery occlusion (BUAO) for the treatment of type II cesarean scar pregnancy (CSP). METHODS: Patients with type II CSP underwent laparoscopy + bilateral uterine artery embolization (control group) or laparoscopy + BUAO (study group). Data regarding the duration of surgery, intraoperative hemorrhage, postoperative complications, the duration of the hospital stay, and the costs of hospitalization were retrospectively collected. One year later, the time to the return of the ß-human chorionic gonadotropin (ß-hCG) concentration to normal and to the return of menstruation were compared. RESULTS: The duration of surgery, time to the return of menstruation, and incidence of postoperative complications in the study group were significantly less than in the control group, but there was no significant difference in the time for ß-hCG to return to normal or the volume of intraoperative hemorrhage. The duration of hospitalization and costs for the control group were higher than those for the study group. CONCLUSION: Laparoscopy in combination with BUAO is associated with minimal trauma, rapid recovery, a short duration of surgery, low cost of hospitalization, and a low postoperative complication rate. Thus, it represents a useful new surgical treatment for type II CSP.

Pregnancy as a ticking bomb: A sonographic review of type II cesarean section scar pregnancy / Philippine Journal of Obstetrics and Gynecology

@#Cesarean section scar pregnancy (CSP) is a pregnancy implanted outside the uterine cavity in the site of a previous cesarean section scar and is considered the rarest form ectopic pregnancy. CSP is a modern phenomenon and has been reported with increasing incidence due to either an increased reporting or increasing cesarean section rate. The true incidence, however, has not been fully determined as some cases will end up in the first trimester and go unreported or undiagnosed. Undiagnosed cesarean scar pregnancy can be fatal due to life threatening hemorrhage as well as uterine rupture due to an abnormally adherent placenta. Accurate diagnosis is important because it enables the clinicians to establish the risk of complications and aid in prompt management. Ultrasonography is often the first step in detecting CSP and MRI should only be used in equivocal cases. The case presented is in a multiparous woman with ultrasound finding of a cesarean scar pregnancy where expectant management was the initial option but because of the outward progression of the CSP, it was terminated. There is no established universal treatment guidelines for CSP and treatment options include expectant, medical, surgical or combinations of these.

Foley Catheter-Assisted Laparoscopic Treatment of Type II Cesarean Scar Pregnancy.

Cesarean scar pregnancy (CSP) is an ectopic pregnancy in which the zygote implants in the scar of a previous cesarean section. In type II CSP the zygote implants more deeply. We report a retrospective case series of 8 patients who underwent laparoscopic surgery with the aid of a Foley catheter deployed in the lower uterine segment under ultrasound guidance at the beginning of the surgery. This approach facilitates locating, identifying, and removing the lesion. It also may reduce bleeding via wound compression.