Uterine-preserving emergency surgery for cesarean scar pregnancies: another medical solution to an iatrogenic problem

• Published in: Fertility and sterility Vol. 91; no. 6; pp. 2623 - 2627
• Main Authors: Halperin, Reuvit, M.D., Ph.D, Schneider, David, M.D, Mendlovic, Sonia, M.D, Pansky, Moty, M.D, Herman, Arie, M.D, Maymon, Ron, M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2009; Elsevier
• Subjects: Abortion, Spontaneous - etiology; Adult; Biological and medical sciences; Cesarean Section - adverse effects; Cesarean Section - methods; Cicatrix - etiology; Cicatrix - surgery; Emergency; Female; Gynecology. Andrology. Obstetrics; Humans; Iatrogenic Disease - prevention & control; Internal Medicine; Medical sciences; Obstetrics and Gynecology; Pregnancy; pregnancy in scar; Pregnancy Trimester, Second; Retrospective Studies; sonography; surgery; treatment; Ultrasonography; Uterus - anatomy & histology; Uterus - diagnostic imaging; Uterus - surgery; treatment; Emergency; pregnancy in scar; sonography; surgery; Sonography; Pregnancy; Iatrogenic; Treatment; Uterus; Surgery; Scar; Gynecology; Obstetrics; Cesarean section
• ISSN: 0015-0282; 1556-5653
• DOI: 10.1016/j.fertnstert.2008.03.021

Objective To supplement existing cases of cesarean scar pregnancy presenting as acute conditions. All of the study women had been treated by a conservative surgical approach. Design Retrospective study. Setting Department of obstetrics/gynecology of a tertiary referral center. Patient(s) We identified six pregnant women at 7-15 weeks' gestation who underwent emergency laparotomy and uterine-preserving surgery. Four of them were initially treated by uterine curettage because of misdiagnosed intrauterine pregnancies. The other two experienced failed methotrexate treatment. Intervention(s) All patients underwent a similar surgical technique while actively bleeding. This included laparotomy and ligation of bilateral uterine arteries, followed by wedge resection of the entire pregnancy in scar. The uterus was sutured in two layers. Main Outcome Measure(s) All the reported women in our series had been cured and their uteruses have been preserved. Result(s) There was an inadvertent injury to the bladder in one case, which was immediately repaired, and blood transfusion was required in two other cases. The postoperative course was uneventful for all the patients. One of the patients has already spontaneously conceived and she had an ongoing normal pregnancy at the time of writing. Conclusion(s) This small case series emphasizes that uterine-preserving surgery is an optional management for cesarean scar pregnancies presenting as acute conditions, cases resistant to medical treatment, or for women at advanced gestation.