Outcomes of Laparoscopic Approach to Cesarean Scar Pregnancy (CSP)

Cesarean scar pregnancy (CSP) is a rare long-term complication after cesarean delivery. In clinical practice, its diagnosis and management is very important because it may be associated with serious consequences. Although a wide range of treatment options have been reported, the best treatment is unrecognized yet. This study aimed to evaluate the outcomes of laparoscopy in CSP.

This non-randomized single-arm clinical trial was conducted on 43 CSP patients who were referred to the educational and medical centers of Isfahan University of Medical Science from 2021 to 2022. All the patients were treated by laparoscopy, and during follow-up, the pregnancy test was measured weekly until the test was negative, and an ultrasound was performed 6 months later. Myometrial thickness and occurrence of isthmocele were checked and recorded. Abnormal uterine bleeding or pelvic pain were also evaluated 6 months later.

Mean time of surgery was 55.12 ± 10.61 minutes, and the rate of intraoperative bleeding was 62.93 ± 24.00 cc. Four cases had excess intraoperative bleeding: two of them received packed cells, and two led to laparotomy. After surgery, the time to negative pregnancy test was 19.21 ± 5.50 days and 4 (10.3%) patients had isthmocele in follow-up sonography. Human chorionic gonadotropin hormone (BHCG) decreased significantly after surgery (percentage reduction: 97.71 ± 3.80; P value < 0.001) and myometrial thickness increased significantly (percentage increase: 46.94 ± 28.66; P value < 0.001).

Laparoscopic excision of a CSP is an effective and feasible technique with the advantage of an immediate myometrial reconstruction.