ArticleF&S reports2025
Treatment of a persistent cesarean scar ectopic pregnancy with hysteroscopic resection after medical management: case report and literature review.
Article in F&S reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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3 authors.
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Abstract
Objective: To report a case and add to the body of evidence on techniques and outcomes of treatments for cesarean scar ectopic pregnancy (CSEP). Design: Case report and literature review. Subjects: Patient with persistent ultrasound evidence of CSEP after medical management and resolution of human chorionic gonadotropin levels. Exposure: Operative hysteroscopy with resection of the persistent CSEP under direct visualization. Main Outcome Measures: Time to resolution, complication rates, and effects on fertility. Results: We report the case of a 30-year-old woman, gravida 2 para 1001 with CSEP diagnosed by ultrasound at 6 weeks and 3 days of gestation, who was initially managed with a dose of methotrexate and was referred for failed medical management. The patient was then diagnosed with a persistent fluid collection measuring 5.0 cm in size within a low transverse cesarean scar, seen on US even after repeat methotrexate dosing and negative human chorionic gonadotropin was confirmed. Operative hysteroscopy with mechanical hysteroscopic tissue morcellation under laparoscopic guidance was performed but was discontinued once the maximum fluid deficit was reached on hysteroscopy. Diagnostic flexible hysteroscopy subsequently confirmed the presence of residual tissue. Repeat hysteroscopy with loop resectoscope achieved complete resolution of CSEP. The patient conceived unassisted 3 months after the procedure with intrauterine implantation confirmed by US at 5 weeks and 2 days of gestation, resulting in live birth. Review of the literature showed published case reports of hysteroscopic resection of CSEP with high chance of success and low complication rate. Conclusion: Hysteroscopic resection is an effective treatment modality for CSEP with persistent gestational sac after medical management that meets the patient care aims of prompt resolution, low reported postoperative complications, and preservation of fertility.
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