Page 64 - World Journal of Laparoscopic Surgery

Laparoscopic Management of Cesarean Scar Pregnancy

Fig. 1: TVS showing a hyperechoic lesion at the level of lower uterine segment

Fig. 2: Shows a bulge after dissecting UV fold of peritoneum

• Relevant investigations were done, beta human chorionic of conception were gently scooped out, scar was excised
gonadothropin (β-hCG) level was 3112 IU/L. Ultrasound and endosuturing was done. (Fig. 2) Products were sent for
examination showed a heteroechoic, predominantly histopathological examination (HPE).
hyperechoic lesion measuring 27 mm × 13 mm in the anterior • Post-scar excision patient was followed up with repeat β-hCG
wall of lower uterine segment with posterior shadowing with on day 3 which was 224 IU/L, showing a declining trend.
increased internal vascularity and another hypoechoic cystic Histopathology revealed endometrial tissue with areas of
lesion measuring 15 mm × 12 mm adjacent to it with no intrinsic hemorrhage and chorionic villi, thus confirming C-section scar
vascularity. Doppler examination showed increased internal ectopic pregnancy.
vascularity scar ectopic (Fig. 1).
• Diagnostic laparoscopy was performed and UV fold was Case 2:
dissected and a soft and vascular mass was noted. Saccular
structure was noted on anterior wall and lower uterine segment • A 35-year-old, G P L with previous two C-sections came with
3 2 2
of 4 cm × 5 cm, incision was taken over the bulge, products history of 2.5 months of amenorrhea and a scan report of single

250 World Journal of Laparoscopic Surgery, Volume 15 Issue 3 (September–December 2022)