Background: There is no consensus regarding the optimal treatment for cesarean scar pregnancy (CSP) because treatment efficacy, safety, and the influence on subsequent pregnancy must be taken into consideration. Here ...Background: There is no consensus regarding the optimal treatment for cesarean scar pregnancy (CSP) because treatment efficacy, safety, and the influence on subsequent pregnancy must be taken into consideration. Here we report our experience with 11 cases of CSP and review the literature regarding subsequent pregnancy. Methods: Records of 11 CSP cases that were treated at our hospital were retrospectively reviewed. CSP was treated by local methotrexate (MTX) injection or laparotomic or laparoscopic removal of the gestational mass and myometrial repair. Outcome of subsequent pregnancy after treatment was followed-up until delivery. Results: Local MTX injection was performed for six cases, laparotomic removal of the gestational mass and myometrial repair was performed for two, and laparoscopic removal of the gestational mass and myometrial repair was performed for three. The uterus was preserved in all cases. After CSP treatment, eight pregnancies occurred in five cases, resulting in six live births and two miscarriages. Conclusion: Advantages and disadvantages of various treatment methods for CSP continue to be elucidated. Serum hCG level, location of the gestational mass, thickness of the lower uterine segment at the time of diagnosis, and whether the patient wishes for fertility preservation should be considered when choosing a treatment plan.展开更多
Laparoscopic surgery is the standard surgical approach for ectopic pregnancy. However, some surgeons prefer laparotomy for patients with acute bleeding. We evaluated four cases of tubal pregnancy with massive hemoperi...Laparoscopic surgery is the standard surgical approach for ectopic pregnancy. However, some surgeons prefer laparotomy for patients with acute bleeding. We evaluated four cases of tubal pregnancy with massive hemoperitoneum (>800 ml) and performed laparoscopic surgery. The patient age ranged from 20 to 37 years, and the gestational age ranged from 5 to 8 weeks. All cases were hemodynamically unstable. Two cases had hemoperitoneum of >2000 mL, which was caused by the rupture of the left isthmus tube. In three cases, surgery could be started within approximately 30 min, and in one case, the start time extended owing to difficulty in anesthesia introduction. Moreover, in three cases, the target lesion was reached within 7 min, and the lesion was excised in approximately 20 min from the start of insufflation, and in one case with a lesion exceeding 7 cm, the time extended. All patients were safely treated via laparoscopic surgery. To initiate surgery without deterioration of the hemodynamic condition, blood transfusion can be started simultaneously with preparation for laparoscopic surgery. Lifting the lesion with a pair of forceps can help immediately stop bleeding, even if it is difficult to secure the visual field owing to massive bleeding. When there is difficulty in anesthesia or a large pregnancy lesion, care should be taken to avoid an increase in the amount of bleeding associated with extension of the perioperative period.展开更多
文摘Background: There is no consensus regarding the optimal treatment for cesarean scar pregnancy (CSP) because treatment efficacy, safety, and the influence on subsequent pregnancy must be taken into consideration. Here we report our experience with 11 cases of CSP and review the literature regarding subsequent pregnancy. Methods: Records of 11 CSP cases that were treated at our hospital were retrospectively reviewed. CSP was treated by local methotrexate (MTX) injection or laparotomic or laparoscopic removal of the gestational mass and myometrial repair. Outcome of subsequent pregnancy after treatment was followed-up until delivery. Results: Local MTX injection was performed for six cases, laparotomic removal of the gestational mass and myometrial repair was performed for two, and laparoscopic removal of the gestational mass and myometrial repair was performed for three. The uterus was preserved in all cases. After CSP treatment, eight pregnancies occurred in five cases, resulting in six live births and two miscarriages. Conclusion: Advantages and disadvantages of various treatment methods for CSP continue to be elucidated. Serum hCG level, location of the gestational mass, thickness of the lower uterine segment at the time of diagnosis, and whether the patient wishes for fertility preservation should be considered when choosing a treatment plan.
文摘Laparoscopic surgery is the standard surgical approach for ectopic pregnancy. However, some surgeons prefer laparotomy for patients with acute bleeding. We evaluated four cases of tubal pregnancy with massive hemoperitoneum (>800 ml) and performed laparoscopic surgery. The patient age ranged from 20 to 37 years, and the gestational age ranged from 5 to 8 weeks. All cases were hemodynamically unstable. Two cases had hemoperitoneum of >2000 mL, which was caused by the rupture of the left isthmus tube. In three cases, surgery could be started within approximately 30 min, and in one case, the start time extended owing to difficulty in anesthesia introduction. Moreover, in three cases, the target lesion was reached within 7 min, and the lesion was excised in approximately 20 min from the start of insufflation, and in one case with a lesion exceeding 7 cm, the time extended. All patients were safely treated via laparoscopic surgery. To initiate surgery without deterioration of the hemodynamic condition, blood transfusion can be started simultaneously with preparation for laparoscopic surgery. Lifting the lesion with a pair of forceps can help immediately stop bleeding, even if it is difficult to secure the visual field owing to massive bleeding. When there is difficulty in anesthesia or a large pregnancy lesion, care should be taken to avoid an increase in the amount of bleeding associated with extension of the perioperative period.
