Page 92 - World Journal of Laparoscopic Surgery

CASE SERIES
Laparoscopic Management of Uncommon Presentations

of Ectopic Pregnancy: A Case Series

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Virupakshi Ajjammanavar , Jayashree S , Abirami Gobinathan , Anjali Siddesh 4
AbstrAct
The incidence of ectopic pregnancy, which constitutes about 2% of all pregnancies, is increasing due to increasing risk factors and availability
of better diagnostic modalities. It is one of the important causes for maternal mortality in the first trimester. Some ectopic pregnancies, usually
the ones in the uterus, may be missed in the initial ultrasound evaluation and require high index of suspicion. If ultrasound is inconclusive,
MRI may help in the diagnosis. Management modalities include expectant, medical, combined medical/surgical, and surgical treatment. In
patients opting for surgery, laparoscopy provides excellent visualization of the pathology, decreases maternal morbidity, and improves the
fertility outcome in future pregnancies. Here we are discussing four rare ectopic pregnancies: two cases of cesarean scar pregnancy, one case
of interstitial pregnancy, and one case of rudimentary horn pregnancy and their successful management by laparoscopy.
Keywords: Cesarean scar pregnancy, Ectopic pregnancy, Interstitial pregnancy, Laparoscopy, Rudimentary horn pregnancy.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1493

IntroductIon 1–4 Department of Obstetrics and Gynaecology, JSS Medical College,
Although ectopic pregnancy constitutes only about 2% of all the JSS AHER, Mysuru, Karnataka, India
pregnancies, it is responsible for 6% of all pregnancy related deaths Corresponding Author: Jayashree S, Department of Obstetrics and
and hence warrants high index of suspicion, proper evaluation, Gynaecology, JSS Medical College, JSS AHER, Mysuru, Karnataka, India,
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and appropriate treatment. Ectopic pregnancies are known to Phone: +91 9620255534, e-mail: drjayashrees@gmail.com
occur in the fallopian tubes (the most common site), cervix, ovary, How to cite this article: Ajjammanavar V, Jayashree S, Gobinathan A,
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abdomen, myometrium, and previous cesarean scar. The risk et al. Laparoscopic Management of Uncommon Presentations of
factors include pelvic inflammatory disease, previous intrauterine Ectopic Pregnancy: A Case Series. World J Lap Surg 2022;15(1):90–93.
instrumentation, previous tubal surgery, previous ectopic, assisted Source of support: Nil
reproductive techniques, and congenital uterine anomalies. Timely Conflict of interest: None
intervention, be it expectant, conservative, or definitive, and vigilant
follow-up prevent rupture and massive hemorrhage and preserve
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future fertility. Although traditional surgical management involves into the myometrium near the site of ectopic. Uterovesical (UV)
laparotomy, laparoscopic approach is now being adopted whenever fold of peritoneum was opened, bladder was pushed down,
possible due to its various advantages in experienced hands. Here thinned-out myometrium over scar ectopic was incised, and
we are discussing a series of four ectopic pregnancies in uncommon contents were aspirated. The rent was sutured with barbed suture.
locations and their surgical management by laparoscopy. Patient was discharged on second postoperative day without any
complications. Histopathological examination (HPE) revealed
cAse 1: cesAreAn scAr PregnAncy products of conception.
A 28-year-old gravida 2 para 1 living 1 with previous cesarean
section (CS) presented to our hospital with complaints of bleeding
per vaginum for 10 days following intake of pills for medical
abortion prescribed at 8 weeks of gestation. She was pale with
a pulse rate 98/minute and blood pressure (BP) 100/70 mm Hg.
On examination, there was lower abdominal tenderness. On per
speculum examination, there was minimal bleeding and uterus
was of normal size with no forniceal tenderness on per vaginal
examination. Ultrasound showed a gestational sac of 3 × 5 cm
with fetal pole and no cardiac activity in the anterior part of the
lower uterine segment near the utero-cervical junction with
empty uterine cavity with extensive vascularity in the area of
previous cesarean scar suggesting cesarean scar pregnancy
(Fig. 1). Informed written consent for laparoscopic surgery was
obtained after explaining different modalities of treatment.
On laparoscopy, cesarean scar ectopic of around 5 × 5 cm was
noted (Fig. 2). Diluted vasopressin (10 U in 100 mL) was injected Fig. 1: Transvaginal ultrasound of cesarean scar pregnancy

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