A Case Report of Conservative Laparoscopic Management of Cesarean Scar Ectopic Pregnancy

Cesarean scar ectopic pregnancy (CSEP) is a rare gynecological disorder affecting about 0.05% of pregnancies and under 0.2% of cesarean scars. The primary aim in treating CSEP is to remove the ectopic tissue and minimize complications while maintaining the patient's fertility. This case report illustrated the successful use of a conservative laparoscopic method to manage a viable CSEP at 14 weeks of gestation.

A 35-year-old woman with a history of five cesarean deliveries and five healthy children was diagnosed with a 14-week viable CSEP through abdominal and transvaginal ultrasounds. The choice of a conservative laparoscopic approach was made to align with her wish to preserve fertility.

The laparoscopic procedure involved several key steps: careful dissection of adhesions between the bladder and uterus, locating the ectopic pregnancy in the lower uterine segment, extracting the pregnancy tissue using an endobag, and suturing the defect in the lower segment. This successful approach not only removed the ectopic pregnancy but also addressed related structural issues, thereby reducing morbidity and preserving the patient's fertility.

This case underscores the value of a conservative laparoscopic strategy for managing CSEP in the second trimester. Accurate diagnosis through imaging is crucial, and minimally invasive techniques provide effective treatment options. Tailoring the approach to the individual patient's needs is essential for optimizing clinical outcomes and respecting patient preferences.

Source: Elbanna W, Azmy O. Conservative Laparoscopic Approach for the Management of a 14-Week Viable Ectopic Cesarean Scar Ectopic Pregnancy. Case Rep Obstet Gynecol. 2024 Oct 4;2024:6682029. doi: 10.1155/2024/6682029. PMID: 39398622; PMCID: PMC11469927.