Conservative Versus Radical Surgical Management of Cesarean Scar Ectopic Pregnancy: A Report of 2 Cases

Cesarean scar ectopic pregnancy (CSEP) is a rare type of ectopic pregnancy that results from implantation of a blastocyst in a previous cesarean scar. It is an emerging complication of increasing cesarean rates. Early diagnosis is imperative to avert maternal morbidity and loss of fertility. Management can be medical, surgical or combination of both modalities. There is currently lack of consensus on optimal management. Treatment is individualized and tailored to the clinical situation and desire for fertility. Two cases of CSP are presented in this report. A 35-year-old G6P5(4014) with four previous cesarean sections (CS) was diagnosed with CSP at 9 weeks gestation. She has completed family and was managed with total abdominal hysterectomy. Intraoperatively, a bulging mass measuring 3 x 2 cm was noted on the left lateral lower uterine segment. On cut section, a niche was noted at the area of the previous CS scar. Within the niche, a gestational sac was noted with a point of rupture and fetus measuring 2 x 1.8 cm (Figure 1). The second case is a 31-year-old G5P3(2-1-1-2) with secondary infertility, three previous cesarean sections, diagnosed with CSP at 5 weeks gestation following ovulation induction – intrauterine insemination. Single dose Methotrexate was given, however, suboptimal decline in serum β-hCG was noted and follow-up sonogram disclosed an embryo with cardiac activity. Diagnostic hysteroscopy and laparoscopic resection of CSP was done. Hysteroscopy revealed ectopic gestational tissue at 12 o’clock position cephalad to the internal cervical os. Laparoscopy revealed an ectopic pregnancy measuring 3 cm bulging beneath vesicouterine serosa (Figure 2). The gestational sac and products of conception were evacuated from the CS scar. Full thickness dehiscence of CS scar was repaired in two layers. These are the first documented cases of CSP in our institution.


MA Melody Diaz

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