Article (Scientific journals)
Efficacy, Safety and Outcomes of the Laparoscopic Management of Cesarean Scar Ectopic Pregnancy as a Single Therapeutic Approach: A Case Series.
Salem Wehbe, Georges; Amara, Inesse Ait; Nisolle, Michelle et al.
2023In Journal of Clinical Medicine, 12 (24), p. 7673
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Keywords :
cesarean scar pregnancy; isthmocele; laparoscopic cesarean scar pregnancy excision; residual myometrium thickness; Medicine (all); General Medicine
Abstract :
[en] A standardized consensus for the management of cesarean scar pregnancy (CSP) is lacking. The study objective is to evaluate the efficacy, safety and outcomes of the laparoscopic management of CSP as a single therapeutic surgical approach without being preceded by vascular pretreatment or vasoconstrictors injection. This is a retrospective bi-centric study, a case series. Eight patients with a future desire to conceive underwent the laparoscopic treatment of unruptured CSPs. Surgery consisted of "en bloc" excision of the deficient uterine scar with the adherent tissue of conception, followed by immediate uterine repair. The data collected for each patient was age, gestity, parity, number of previous c-sections, pre-pregnancy isthmocele-related symptoms, gestational age, fetal cardiac activity, initial β-human chorionic gonadotropin levels, intra-operative blood loss, blood transfusion, operative time and the postoperative complications, evaluated according to Clavien-Dindo classification. The CSP was successfully removed in all patients by laparoscopy. The surgical outcomes were favorable. All patients with histories of isthmocele-related symptoms reported postoperative resolution of symptoms. The median residual myometrium thickness increased significantly from 1.2 mm pre-operatively to 8 mm 3 to 6 months after surgery. The laparoscopic management seems to be an appropriate treatment of CSP when performed by skilled laparoscopic surgeons. It can be safely proposed as a single surgical therapeutic approach. Larger series and further prospective studies are needed to confirm this observation and to affirm the long-term gynecological and obstetrical outcomes of this management.
Disciplines :
Reproductive medicine (gynecology, andrology, obstetrics)
Author, co-author :
Salem Wehbe, Georges;  Department of Obstetrics and Gynecology, University Hospital Brugmann, Free University of Brussels, 1020 Brussels, Belgium
Amara, Inesse Ait;  Department of Obstetrics and Gynecology, University Hospital Brugmann, Free University of Brussels, 1020 Brussels, Belgium
Nisolle, Michelle  ;  Centre Hospitalier Universitaire de Liège - CHU > > Service de gynécologie-obstétrique (CHR)
Badr, Dominique A ;  Department of Obstetrics and Gynecology, University Hospital Brugmann, Free University of Brussels, 1020 Brussels, Belgium
Timmermans, Marie ;  Centre Hospitalier Universitaire de Liège - CHU > > Service de gynécologie-obstétrique (CHR)
Karampelas, Stavros ;  Department of Obstetrics and Gynecology, University Hospital Brugmann, Free University of Brussels, 1020 Brussels, Belgium
Language :
English
Title :
Efficacy, Safety and Outcomes of the Laparoscopic Management of Cesarean Scar Ectopic Pregnancy as a Single Therapeutic Approach: A Case Series.
Publication date :
14 December 2023
Journal title :
Journal of Clinical Medicine
eISSN :
2077-0383
Publisher :
Multidisciplinary Digital Publishing Institute (MDPI), Switzerland
Volume :
12
Issue :
24
Pages :
7673
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 26 January 2024

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