Successful direct bipolar resection of 6th week cesarean scar pregnancy: case report and literature review

Abstract

Cesarean scar pregnancy is a specific ectopic pregnancy implanted in the scar tissue of a previous cesarean section. To date, no clear consensus exists regarding its management and treatment. Timely diagnosis of this condition is fundamental, owing to the high rate of life-threatening complications and massive hemorrhage. The use of high-definition transvaginal ultrasound is strongly recommended as a first-line diagnostic approach. A wide range of medical and surgical strategies has been described in the literature, including methotrexate administration, local injection of embryocides, uterine curettage, and laparoscopic surgery. The treatment goal should be complete and efficient without compromising the chance of future pregnancies. Recently, many cases were successfully treated through the hysteroscopic route. Illustrating the case of an early detected cesarean scar pregnancy originally treated in our institution with direct bipolar resection, we reviewed the literature regarding the advantages and efficacy of the hysteroscopic approach in terms of fertility preservation, rapid recovery, and safety. In conclusion, the use of a direct hysteroscopic approach could represent a valuable strategy in the first stage of cesarean scar pregnancy.

Keywords: Bipolar resectoscope; Cesarean scar pregnancy; Ectopic pregnancy; Endoscopy; Hysteroscopy.