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                                                                                10.5005/jp-journals-10033-1322
                                                                              Laparoscopy in Cesarean Scar Pregnancy
          RevieW ARticLe

          Laparoscopy in Cesarean Scar Pregnancy

          R Meenakshi Menon


          ABSTRACT                                            detection is possible, mean gestational age at diagnosis
          Introduction: With the increase in rates of cesarean deliveries,   being 7.5 ± 2.5 weeks with interval between last cesarean
          complications in subsequent pregnancies like placenta accreta/  section and CSP being 6 months to 12 years. 1
          percreta, uterine rupture, and cesarean scar ectopic pregnancy   Cesarean scar pregnancy has been hypothesized
          are on the rise. Cesarean scar pregnancy (CSP) accounts for   to occur from an early invasion of myometrium which
          about 2 to 4% of all ectopic pregnancies. Improvement in diag-
          nostic techniques and advancement in transvaginal ultrasound   occurs through a microscopic tract in the cesarean scar
          and advent of minimal access surgery has contributed to early  tissue. 2
          detection and timely management of CSP.                Two types of CSP have been explained: Endogenic or
          Objective: This article aims to review different treatment   type I and exogenic or type II. Endogenic CSP progresses
          modalities of CSP and hence to compare efficacy of laparo­  toward cervicoisthmic space, or uterine cavity could
          scopy with other management techniques.             progress to viability but with high risk of bleeding from
          Materials and methods: Case series, retrospective cohort  placental site.
          studies, and articles were reviewed which included studies from   Type II progresses toward bladder or abdominal
          PubMed, MEDLINE, Cochrane library, and EMBASE. The main   cavity with deep invasion of scar defect. Type II usually
          outcome was successful first­line treatment. Complications
          during treatment were listed as bleeding more than 1 L, blood   complicates with uterine rupture or bleeding early in
          transfusion, hysterectomy, and laparotomy.          pregnancy. 3
                                                                 Ultrasound plays a pivotal role in diagnosis. Cesar-
          Results: Successful treatment and reduced complications
          were noted with laparoscopy as compared with medical     ean scar pregnancy (Fig. 1) is characterized by certain
                                                                               4
          management.                                         ultrasound findings :
          Conclusion: Interventional than medical approach is preferred   •  Empty uterus and cervical canal
          in management of CSP. Laparoscopic surgery helps in removal  •  Gestational Saction located in anterior uterine wall (part
          of ectopic tissue in cesarean scar with simultaneous repair of   of isthmus) with diminished or absent myometrium
          the defect under adequate visualization.               between gestational sac and bladder and discontinuity
          Keywords: Cesarean scar pregnancy, Ectopic pregnancy,   in anterior wall of uterus adjacent to gestational sac
          Laparoscopy.                                        •  Circular blood flow surrounding the sac on Doppler.
          How to cite this article: Menon RM. Laparoscopy in Cesarean   Aborting gestation and cervical pregnancy are easily
          Scar Pregnancy. World J Lap Surg 2017;10(3):135-138.  mistaken for a CSP.
          Source of support: Nil                                 Early diagnosis with high index of suspicion and timely
                                                              management depending on the availability, skill of surgeon,
          Conflict of interest: None
                                                              and severity of symptoms are of prime importance.
                                                                 The treatment options available and reviewed are
          INTRODUCTION                                        •  Dilation and curettage (D&C) and excision of tropho-

          National Family Health Survey 2014 to 2015 reveals that   blastic tissue using laparoscopy or laparotomy
          rate of cesarean surgery has doubled over the last decade   •  Local or systemic methotrexate (MTX)
          from 8.5% in 2005 to 17.2% in 2015. Thus, complications
          like CSP have also been on the rise. Incidence of CSP has
          been reported to be 1 in 1,800 to 1 in 2,200 pregnancies.
          With the advent of transvaginal ultrasonography, early



           Senior Resident
           Department of Obstetrics and Gynecology, St. John’s Medical
           College Hospital, Bengaluru, Karnataka, India
           Corresponding Author: R Meenakshi Menon, 1069, Poorna
           Shree, Sector 7, HSR Layout, Bengaluru 560102, Karnataka
           India, Phone: +919746758373, e-mail: rmeenamenon@
           gmail.com
                                                                     Fig. 1: Ultrasonographic view of a scar ectopic
          World Journal of Laparoscopic Surgery, September-December 2017;10(3):135-138                     135
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