Successful term pregnancy after treatment of a cesarean scar ectopic gestation by endoscopic technique and conservative therapy

Korkontzelos, Ioannis; Tsirkas, Panagiotis; Antoniou, Nikolaos; Souliotis, Dimitrios; Kosmas, Ioannis

doi:10.1016/j.fertnstert.2008.04.027

« Previous Next »Fertility and Sterility
Volume 90, Issue 5 , Pages 2010.e13-2010.e15, November 2008

Successful term pregnancy after treatment of a cesarean scar ectopic gestation by endoscopic technique and conservative therapy

Ioannis Korkontzelos, M.D.
- Department of Obstetrics and Gynecology, Ioannina State General Hospital “G. Chatzikosta,” Ioannina, Greece
- Reprint requests: Ioannis Korkontzelos, M.D., Minimally Invasive Therapy Unit and Endoscopy Training Centre, University Department of Obstetrics and Gynaecology, Royal Free Hospital, Pond Street Hampstead, London NW3 2QG, England.
Panagiotis Tsirkas, M.D.
- Department of Obstetrics and Gynecology, Ioannina State General Hospital “G. Chatzikosta,” Ioannina, Greece
Nikolaos Antoniou, M.D., Ph.D.
- Department of Obstetrics and Gynecology, Ioannina State General Hospital “G. Chatzikosta,” Ioannina, Greece
Dimitrios Souliotis, M.D.
- Department of Anesthesiology, Ioannina State General Hospital “G. Chatzikosta,” Ioannina, Greece
Ioannis Kosmas, M.D.
- Department of Obstetrics and Gynecology, Ioannina State General Hospital “G. Chatzikosta,” Ioannina, Greece

Received 7 February 2008; received in revised form 12 April 2008; accepted 12 April 2008. published online 04 August 2008.

Objective

To describe a case of cesarean scar pregnancy treated successfully by endoscopic technique and medical therapy.

Design

Case report.

Setting

State general hospital in a major city.

Patient(s)

A 32-year-old woman with two cesarean sections and a recent curettage presented with ectopic cesarean scar pregnancy.

Intervention(s)

Transvaginal ultrasound and hysteroscopy were used for diagnosis, and conservative therapy with methotrexate and hysteroscopy to treat the patient.

Main Outcome Measure(s)

Modified hysteroscopic technique and outcome.

Result(s)

Sonography and hysteroscopy revealed the presence of a gestational sac in the lower segment of the uterus in a patient with a cesarean section scar. She was successfully treated with systemic methotrexate and aspiration of the sac and local methotrexate injection under endoscopic control.

Conclusion(s)

Endoscopic intervention combined with medical treatment can result in a good therapeutic outcome with preservation of fertility in early ectopic cesarean scar pregnancy.

Key Words: Ectopic cesarean scar pregnancy, endoscopy, methotrexate, fertility