Laparoscopic treatment of cesarean scar pregnancy: A scoping review

Abstract

Cesarean Scar Pregnancy (CSP) is a life-threatening condition that may lead to uterine rupture and severe bleeding when left untreated. Treatment includes expectant, medical, and surgical options. This review aimed to evaluate the role of laparoscopy in the management of CSP. A comprehensive search of PubMed and The Cochrane Library was carried out with findings dating up to May 2024. Several screening processes were done by two reviewers and 48 articles mentioning the laparoscopic management were included in this review. Laparoscopy allows adhesiolysis, bladder dissection, and complete CSP excision in addition to simultaneous repair of the isthmocele, reinforcing the scarred myometrium to prevent abnormal uterine bleeding, pelvic pain, CSP recurrence, and rupture. To ensure a successful indication of laparoscopy as the main treatment option, the CSP gestational sac should be > 32.5 mm, with a myometrial thickness of < 2 mm. Laparoscopy for CSP excision is a durable and highly effective method with minimal complication rates reported in the current literature. Moreover, it seems to be the most effective in the case of CSP embedded within myometrium with or without serosal involvement.

Keywords: Cesarean scar pregnancy; Complications; Hysteroscopy; Laparoscopy; Pregnancy rates.