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Endoscopic treatment of ectopic pregnancy in a cesarean scar.
MedLine Citation:
PMID:  20934923     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
STUDY OBJECTIVE: To describe our experience with endoscopic removal of cesarean scar pregnancy.
DESIGN: Retrospective study (Canadian Task Force classification II-3).
SETTING: Tertiary-care university hospital.
PATIENTS: Twenty-one patients with cesarean scar pregnancy.
INTERVENTIONS: All the patients underwent removal of pregnancy mass at hysteroscopy or combined with laparoscopy. Nine patients received a methotrexate injection before the operation, and 13 underwent uterine artery embolization before surgery.
MEASUREMENTS AND MAIN RESULTS: Clinical data, serum β-human chorionic gonadotropin concentration, findings of ultrasound or magnetic resonance imaging examinations, therapeutic options, operative time, operative blood loss, and duration of hospitalization time were recorded. The mean serum β-human chorionic gonadotropin concentration at diagnosis was 53 350.4 IU/ L. Seventeen patients underwent hysteroscopy, which failed in 2, and the other 4 patients underwent hysteroscopy combined with laparoscopy. Mean operative time was 51.4 minutes, and mean blood loss was estimated at 48.1 mL. A gestational mass can be removed at hysteroscopy, with rapid recovery and a high success rate. If a cesarean scar pregnancy mass grows toward the bladder and abdominal cavity, hysteroscopy combined with laparoscopy is more appropriate. Preoperative uterine artery embolization can decrease blood loss substantially during the operation. No patients underwent hysterectomy.
CONCLUSIONS: Endoscopy seems to be the optimal surgical management in patients with a cesarean scar pregnancy and who desire to preserve the uterus and fertility. However, further study is warranted.
Authors:
Hua Li; Hong-Yan Guo; Jing-Song Han; Jian-Liu Wang; Guang-Wu Xiong; Jie Shen; Jia-Jia Zhang
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Publication Detail:
Type:  Journal Article     Date:  2010-10-08
Journal Detail:
Title:  Journal of minimally invasive gynecology     Volume:  18     ISSN:  1553-4650     ISO Abbreviation:  J Minim Invasive Gynecol     Publication Date:    2011 Jan-Feb
Date Detail:
Created Date:  2011-01-03     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101235322     Medline TA:  J Minim Invasive Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  31-5     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 AAGL. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Obstetrics and Gynecology, Third Hospital, Beijing, China.
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