Transvaginal surgical treatment of cesarean scar ectopic pregnancy

Abstract

Purpose: To explore the feasibility of surgical management of cesarean scar ectopic pregnancy (CSEP) using a transvaginal approach.

Methods: Thirty-eight patients with CSEP presenting at the Shenzhen Nanshan People's hospital between January 2008 and May 2012 were reviewed in the study. Ten patients underwent uterine artery embolization, 13 patients underwent endoscopic CSEP removal in combination with chemotherapy and 15 received transvaginal surgical therapy (transvaginal group). Patients were followed up for between 3 and 48 months.

Results: Postoperative fever and irregular menstrual bleeding after healing were each observed in one of ten patients undergoing embolization. No pregnancies were reported in this group during follow-up. Endoscopy procedures included two patients undergoing laparoscopy and 11 undergoing hysteroscopy resection. There were six pregnancies during follow-up in this group. Transvaginal surgery was performed uneventfully in all cases. All patients recovered without complications. There were no reports of irregular menstrual bleeding or changes in menstrual blood volume. Serum HCG levels declined rapidly to within the normal range. The time to menstrual cycle recovery (29.2 ± 5.7 days) was significantly shorter than with endoscopic surgery (37.6 ± 8.2 days) or embolization (64.4 ± 9.2 days; P < 0.05). Three patients became pregnant after transvaginal surgery.

Conclusion: Transvaginal removal of ectopic pregnancy tissue is a new surgical approach for the treatment of CSEP. The efficacy and safety of the approach needs further confirmation.