Page 63 - World Journal of Laparoscopic Surgery

CASE SERIES
Laparoscopic Management of Cesarean Scar Pregnancy:

A Case Series

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Virupaksha A , Soumya Rajshekar Patil , Jayashree S , Madhuri N 4
Received on: 25 January 2022; Accepted on: 06 September 2022; Published on: 07 December 2022
AbstrAct
Cesarean scar pregnancy (CSP) stands as a unique variety of ectopic gestation. The incidence is on rise ever since the steady rise with the
number of cesarean (C-section) deliveries and improved technology. By means of sonography in the past few decades, there has been a rise
in detection rates of CSP. Life-threatening complications, such as uterine rupture, hemorrhage, hypovolemia, and even death, are associated
with CSP. Literature on scar ectopic is sparse, it is essential to report all cases of C-section scar ectopic so as to get a better understanding of its
management as well as to create awareness on the possibility of this entity. In this regard, we are reporting three cases of C-section scar ectopic
which were successfully managed by laparoscopy.
Keywords: Cesarean scar pregnancy, Laparoscopic excision of cesarean scar ectopic, Scar ectopic.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1528

bAckground 1–4 Department of Obstetrics and Gynaecology, JSS Medical College,
Cesarean scar pregnancy stands as a unique variety of ectopic Mysuru, Karnataka, India
gestation where the implantation occurs within the muscle or Corresponding Author: Madhuri N, Department of Obstetrics and
fibrous tissue of the scar after a previous C-section. The condition Gynaecology, JSS Medical College, Mysuru, Karnataka, India, Phone:
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was first described in 1978 by Larsen and Solomon. The incidence +91 99459073921, e-mail: madhurin@jssuni.edu.in
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ranges from 1 in 1800 to 1 in 2216 pregnancies. Cesarean scar How to cite this article: Virupaksha A, Patil SR, Jayashree S, et al.
pregnancy accounts for 6.1% of all ectopic pregnancies, and 0.15% Laparoscopic Management of Cesarean Scar Pregnancy: A Case Series.
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of pregnancies with previous scar. Ever since the steady rise with World J Lap Surg 2022;15(3):249–254.
the number of C-section deliveries and improved technology by Source of support: Nil
means of sonography in the past few decades, there has been a Conflict of interest: None
rise in detection rates of CSP.
The ultrasound diagnostic criteria of scar ectopic gestation
include the undermentioned: cAse description
For writing these reports, oral consent was obtained from the
• Anterior part of the lower uterine segment demonstrates a patients.
gestational sac within.
• An empty uterus and cervical canal. Case 1:
• Absence of a layer of myometrium between the bladder wall
and the sac, a crucial point in differentiating scar pregnancy • A 35-year-old G P L A with a previous one C-section, presented
3 1 1 1
from cervical pregnancy. 4 to emergency department with complaints of intermittent
bleeding per vagina and pain abdomen for one month. The
Most of the CSPs are reported in the first trimester. Although rare, previous C-section was done for fetal distress 10 years ago and
CSP can present at latter period of gestation with catastrophic an induced abortion at two months for which she underwent
complications. One case of CSP has been reported at 35 weeks of dilatation and curettage 2 years ago. The current pregnancy was
gestation during which hysterectomy had to be performed. 5 detected by urine pregnancy test (UPT) at home after 2 months
Complications related to CSP can be serious and include uterine of amenorrhea.
rupture, severe life-threatening hemorrhage, hypovolemia, and • There was a history of over-the-counter medical termination of
even death. If left undiagnosed, it may lead to abnormally invasive pregnancy (MTP) pills intake one month ago when UPT was positive
placenta and immense vascularity at the site of implantation and and from then on, she had bleeding per vagina intermittently. She
poor contractility of the lower segment resulting in tremendous visited a local primary healthcare center (PHC) and was diagnosed
hemorrhage which can become challenging to regulate. 1,6 as having incomplete abortion. Dilatation and curettage were
Since the literature on scar ectopic is sparse, it is essential to report attempted at the PHC, following which she bled profusely and
all cases of C-section scar ectopic so as to get a better understanding was referred to higher center for further management.
of its management as well as to create awareness on the possibility • On examination, tachycardia and pallor were noted. Speculum
of this entity when we are treating a pregnant woman with previous examination revealed an open cervical opening in the cervix (OS)
C-section with an aim to timely diagnose and treat before compli- and minimal bleeding per vagina. On bimanual examination,
cations set in. In this regard, we are reporting three cases of C-section cervix was bulky with an open OS, uterus anteverted and
scar ectopic which were successfully managed by laparoscopy. bilateral fornices were free and non-tender.

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