A three-step evaluation for safer curettage treatment of cesarean scar pregnancy

Abstract

Dilation and curettage is one of the treatment options for cesarean scar pregnancy, however, it sometimes requires a salvage therapy. Few reports discuss the methods of evaluating cesarean scar pregnancy before therapeutic procedures. We aimed to present a case study in which a three-step approach using a combination of preoperational sonohysterography, hysteroscopy, and laparoscopy was performed to evaluate cesarean scar pregnancy. A 33-year-old, G2P2, Japanese female with a history of two elective cesarean sections was diagnosed with viable cesarean scar pregnancy. We used the three-step approach right after undergoing bilateral uterine artery embolization and confirmed that there was a low possibility of fatal complications and we performed dilation and curettage. These steps could be done safely even if the cesarean scar pregnancy was viable. To perform safer curettage on cesarean scar pregnancy patients, these three steps seem to be useful.

Keywords: cesarean scar pregnancy; cesarean section; endoscopy; pregnancy loss.

Figure 1

(A) Transvaginal ultrasonography on admission showing the thin anterior uterine myometrium (2.5 mm) and the gestational sac attached to the cesarean scar. (B) Sonohysterography showing the gestational sac floating in the water.

Figure 2

(A) Hysteroscopy showing a gap between the wall and the attached part of the gestational sac. (B) Laparoscopy with a light. No bulging was seen on the vesicouterine pouch. (C) Intra-abdominal space the light turned off. The light from the hysteroscope was not observed.